J Med Econ. 2012;15(6):1110-7. doi: 10.3111/13696998.2012.703632. Epub 2012 Jul 6.
Secondary hyperparathyroidism (SHPT) is a frequent complication of CKD with incidence, prevalence, and costs increasing worldwide. The objective of this analysis was to estimate therapy cost of SHPT in a sub-population of the FARO study.
In the FARO study, an observational survey aimed to evaluate patterns of treatment in patients with SHPT who had undergone hemodialysis, pharmacological treatments and biochemical parameters evolution data were collected in four surveys. Patients maintaining the same treatment in all sessions were grouped by type of treatment and evaluated for costs from the Italian National Health Service perspective.
Four cohorts were identified: patients treated with oral (PO) calcitriol (n=182), intravenous (IV) calcitriol (n=34), IV paricalcitol (n=62), and IV paricalcitol+cinacalcet therapy (n=20); the cinacalcet monotherapy group was not analysed due to low number of patients (n=9). Parathyroid hormone (PTH) level at baseline and effectiveness of treatments in suppressing PTH level were assessed to test comparability among cohorts: calcitriol PO patients were significantly less severe than others (PTH level at baseline lower than 300 pg/ml; p<0.0001); calcitriol IV patients did not reach significant reduction in PTH level. Paricalcitol and paricalcitol+cinacalcet treatment groups results were comparable, while only the IV paricalcitol cohort's PTH level, weekly dosage, and cost decreased significantly from the first to the fourth survey (p=0.020, p=0.012, and p=0.0124, respectively). Total costs per week of treatment (including calcium-based phosphate binder and sevelamer) were significantly lower in the paricalcitol vs paricalcitol+cinacalcet cohort (p<0.001). Major limitations of this study are related to the survey design: not controlled and lack of comparability between cohorts; however, reflective of true practice patterns.
The IV Paricalcitol cohort had significantly lower treatment costs compared with patients treated with paricalcitol+calcimemtics (p<0.001), without a significant difference in terms of baseline severity and PTH control.
继发性甲状旁腺功能亢进症（SHPT）是慢性肾脏病（CKD）的常见并发症，其发病率、患病率和治疗费用在全球范围内呈上升趋势。本分析旨在评估 FARO 研究的亚人群中 SHPT 的治疗成本。
在 FARO 研究中，一项观察性调查旨在评估接受血液透析的 SHPT 患者的治疗模式，共进行了四次调查，以收集药物治疗和生化参数变化数据。将所有治疗方案相同的患者按治疗类型分组，并从意大利国家卫生系统的角度评估成本。
共确定了四个队列：口服（PO）骨化三醇（n=182）、静脉（IV）骨化三醇（n=34）、IV 帕立骨化醇（n=62）和 IV 帕立骨化醇+西那卡塞治疗（n=20）；由于患者数量较少（n=9），未对西那卡塞单药治疗组进行分析。评估甲状旁腺激素（PTH）基线水平和治疗对 PTH 水平的抑制效果，以检验队列之间的可比性：PO 骨化三醇患者的病情明显较轻（基线时 PTH 水平低于 300 pg/ml；p<0.0001）；IV 骨化三醇患者未达到显著降低 PTH 水平的效果。帕立骨化醇和帕立骨化醇+西那卡塞治疗组的结果相当，而仅 IV 帕立骨化醇组的 PTH 水平、每周剂量和成本从第一次调查到第四次调查显著降低（p=0.020、p=0.012 和 p=0.0124）。与帕立骨化醇+西那卡塞组相比，帕立骨化醇组的每周治疗费用（包括钙基磷酸盐结合剂和司维拉姆）显著降低（p<0.001）。本研究的主要局限性与调查设计有关：未进行对照，各队列之间缺乏可比性；然而，这反映了真实的治疗模式。
与接受帕立骨化醇+钙剂治疗的患者相比（p<0.001），IV 帕立骨化醇组的治疗费用显著降低，而基线严重程度和 PTH 控制方面无显著差异。
