Centre de recherche Hôpital Maisonneuve-Rosemont, Montréal, Canada.
BMC Nephrol. 2013 May 3;14:100. doi: 10.1186/1471-2369-14-100.
Recent trends in parathyroidectomy rates are not known. Our objective was to investigate the trend in parathyroidectomy rates between 2001 and 2010, and to evaluate if the availability and reimbursement of cinacalcet modified that trend.
Using a provincial administrative database, we included all adult patients receiving chronic dialysis treatments between 2001 and 2010 (incident and prevalent) in a time series analysis. The effect of cinacalcet availability on parathyroidectomy bimonthly rates was modeled using an ARIMA intervention model using different cut-off dates: September 2004 (Health Canada cinacalcet approval), January 2005, June 2005, January 2006, June 2006 (date of cinacalcet provincial reimbursement), and January 2007.
A total of 12 795 chronic dialysis patients (mean age 64 years, 39% female, 82% hemodialysis) were followed for a mean follow-up of 3.3 years. During follow-up, 267 parathyroidectomies were identified, translating to an average rate of 7.0 per 1000 person-years. The average parathyroidectomy rate before cinacalcet availability was 11.4 /1000 person-years, and 3.6 /1000 person-years after cinacalcet public formulary listing. Only January 2006 as an intervention date in the ARIMA model was associated with a change in parathyroidectomy rates (estimate: -5.58, p = 0.03). Other intervention dates were not associated with lower parathyroidectomy rates.
A reduction in rates of parathyroidectomy was found after January 2006, corresponding to cinacalcet availability. However, decreased rates may be due to other factors occurring simultaneously with cinacalcet introduction and further studies are needed to confirm these findings.
甲状旁腺切除术的流行率趋势尚不清楚。本研究旨在调查 2001 年至 2010 年间甲状旁腺切除术流行率的趋势，并评估西那卡塞的可及性和报销是否改变了这一趋势。
使用省级行政数据库，我们纳入了 2001 年至 2010 年间（发病和现患）所有接受慢性透析治疗的成年患者，采用时间序列分析。使用 ARIMA 干预模型，根据不同的截止日期（2004 年 9 月（加拿大西那卡塞批准）、2005 年 1 月、2005 年 6 月、2006 年 1 月、2006 年 6 月（西那卡塞省级报销日期）和 2007 年 1 月）评估西那卡塞可用性对甲状旁腺切除术每两个月发生率的影响。
共纳入 12795 例慢性透析患者（平均年龄 64 岁，39%为女性，82%为血液透析），平均随访 3.3 年。随访期间，共发现 267 例甲状旁腺切除术，平均发生率为 7.0/1000 人年。在西那卡塞可用之前，甲状旁腺切除术的平均发生率为 11.4/1000 人年，在西那卡塞进入公共处方后为 3.6/1000 人年。仅 ARIMA 模型中的 2006 年 1 月作为干预日期与甲状旁腺切除术率的变化相关（估计值：-5.58，p=0.03）。其他干预日期与较低的甲状旁腺切除术率无关。
自 2006 年 1 月以来，甲状旁腺切除术的发生率下降，与西那卡塞的可用性相关。然而，较低的发生率可能是由于与西那卡塞引入同时发生的其他因素所致，需要进一步研究来证实这些发现。
