CRES, University Pompeu Fabra, Barcelona, Spain.
Department of Basic Medical Sciences, University of Lleida, Lleida, Spain.
Adv Ther. 2021 Oct;38(10):5333-5344. doi: 10.1007/s12325-021-01895-4. Epub 2021 Sep 14.
To analyze the economic burden of secondary hyperparathyroidism (sHPT) in Spain by quantifying differences in costs of pharmacological treatments and associated cardiovascular events (CVE) between renal patients with and without sHPT.
We used data collected in the NEFRONA cohort study and obtained treatment and CVE costs from the BOT PLUS database and Hospital Discharge Records in the Spanish Health System (CMBD-H), respectively. We examined data from 2445 renal patients followed during 2 years for chronic kidney disease (CKD) progression and 4 years for CVE, stratifying by presence of sHPT. Patient characteristics, administered treatments and CVE were directly extracted from NEFRONA registries. Dosage for each treatment regimen was assumed based on guidelines and multiplied by official unit costs to obtain treatment costs. Costs of CVE were based on ICD-9-CM.
Prevalence of sHPT in the cohort was 65.6% (63.6; 67.6). Average yearly pharmacological costs for patients without sHPT were 610.33€, while costs were 1483.17€ for sHPT patients (average increase of 143.0%). Two hundred three patients registered CVE, resulting in 4-year average costs of 582.57€ for non-sHPT patients compared to 941.87€ for sHPT patients (61.7% average increase). Bivariate analyses considering presence of dialysis, hypercalcemia or hyperphosphatemia and stratified by sHPT showed higher costs for sHPT patients.
These results show that sHPT is associated with substantially higher costs of both, pharmacological treatments and associated CVEs. Preventing the development of sHPT with early management in the course of CKD could possibly lead to better health outcomes and cost balance for health care systems.
通过量化伴有和不伴有继发性甲状旁腺功能亢进症（sHPT）的肾患者在药物治疗成本和相关心血管事件（CVE）方面的差异，分析西班牙继发甲状旁腺功能亢进症的经济负担。
我们使用 NEFRONA 队列研究中收集的数据，并分别从 BOT PLUS 数据库和西班牙卫生系统的住院记录（CMBD-H）获得治疗和 CVE 成本。我们检查了 2445 名接受慢性肾脏病（CKD）进展 2 年和 CVE 4 年随访的肾患者的数据，按是否存在 sHPT 进行分层。患者特征、治疗方案和 CVE 均直接从 NEFRONA 登记册中提取。根据指南假设每种治疗方案的剂量，并乘以官方单位成本以获得治疗成本。CVE 的成本基于 ICD-9-CM。
队列中 sHPT 的患病率为 65.6%（63.6；67.6）。无 sHPT 患者的年平均药物治疗费用为 610.33 欧元，而 sHPT 患者的费用为 1483.17 欧元（平均增加 143.0%）。203 名患者发生 CVE，导致非 sHPT 患者的 4 年平均成本为 582.57 欧元，而 sHPT 患者的成本为 941.87 欧元（平均增加 61.7%）。考虑到存在透析、高钙血症或高磷血症，并按 sHPT 分层的双变量分析显示，sHPT 患者的成本更高。
这些结果表明，sHPT 与药物治疗和相关 CVE 的成本都显著增加有关。通过在 CKD 过程中进行早期管理来预防 sHPT 的发生，可能会为医疗保健系统带来更好的健康结果和成本平衡。
