Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.
Department of Pharmacy, Lianyungang Second People's Hospital, Lianyungang, China.
Front Public Health. 2021 Jul 21;9:712027. doi: 10.3389/fpubh.2021.712027. eCollection 2021.
Chronic Kidney Disease (CKD) is a global chronic disease with increasing prevalence in recent years, particularly CKD accompanied by Secondary Hyperparathyroidism (SHPT) leads to reduced quality of life, increased mortality, a considerable economic burden for patients and society. The aim of this study was to investigate the cost-effectiveness analysis of paricalcitol vs. calcitriol + cinacalcet for CKD patients with SHPT in China in 2020. A Markov model was conducted employing data derived from published literature, clinical trials, official sources, and tertiary public hospital data in China, based on a 10-year horizon from the perspective of the healthcare system. Calcitriol + Cinacalcet was used as the reference group. CKD stage 5 (CKD-5) dialysis patients suffering from SHPT were included in the study. Effectiveness was measured in quality-adjusted life years (QALYs). The discount rate (5%) was applied to costs and effectiveness. Sensitivity analysis was performed to confirm the robustness of the findings. The base case analysis demonstrated that Patients treated with paricalcitol could gain an increase in utility (0.183 QALYs) and require fewer expenditures (6925.612 yuan). One-way sensitivity analysis was performed to showed that impact factors were the price of cinacalcet, the hospitalization costs of patients with paricalcitol and calcitriol, the costs and utilities of hemodialysis and the costs of calcitriol, the costs of paricalcitol regardless of period. Probabilistic simulation analysis displayed when willingness-to-pay was ¥217113, the probability that Paricalcitol was dominant is 96.20%. The results showed that paricalcitol administrated to treat patients diagnosed with Secondary hyperparathyroidism in Chronic Kidney Disease, compared to calcitriol and cinacalcet, might be dominant in China.
慢性肾脏病（CKD）是一种全球性的慢性疾病，近年来其患病率呈上升趋势，尤其是伴有继发性甲状旁腺功能亢进症（SHPT）的 CKD，会降低生活质量，增加死亡率，并给患者和社会带来相当大的经济负担。本研究旨在探讨 2020 年中国 CKD-SHPT 患者中帕立骨化醇与骨化三醇+西那卡塞的成本效果分析。采用马尔可夫模型，基于已发表文献、临床试验、官方来源和中国三级公立医院数据，从医疗保健系统的角度出发，对 10 年的时间进行了研究。以骨化三醇+西那卡塞为参照组。纳入患有 SHPT 的 CKD 5 期（CKD-5）透析患者。以质量调整生命年（QALY）衡量疗效。对成本和疗效进行了 5%的贴现率处理。进行敏感性分析以确认研究结果的稳健性。基础案例分析表明，接受帕立骨化醇治疗的患者可以获得效用（0.183 QALY）的增加，且支出减少（6925.612 元）。单因素敏感性分析表明，影响因素是西那卡塞的价格、帕立骨化醇和骨化三醇患者的住院费用、血液透析的成本和效用、骨化三醇的成本、帕立骨化醇的成本，无论治疗周期如何。概率模拟分析显示，当支付意愿为 217113 元时，帕立骨化醇占优的概率为 96.20%。结果表明，在中国，与骨化三醇和西那卡塞相比，帕立骨化醇治疗继发性甲状旁腺功能亢进症的患者可能具有优势。
