Perrone Valentina, Dovizio Melania, Veronesi Chiara, Andretta Margherita, Bartolini Fausto, Cavaliere Arturo, Ferrante Fulvio, Lupi Alessandro, Pagliaro Romina, Pagnotta Rita, Palcic Stefano, Re Davide, Ubertazzo Loredana, Vercellone Adriano, Degli Esposti Luca
CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40121 Bologna, Italy.
UOC Territorial Pharmaceutical Service, Azienda ULSS 8 Berica, 36100 Vicenza, Italy.
Healthcare (Basel). 2022 Apr 11;10(4):709. doi: 10.3390/healthcare10040709.
This Italian real-world data analysis evaluated the pharmaco-utilization of calcimimetics, cinacalcet or etelcalcetide, and the economic burden of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients. From 1 January 2010 to 30 June 2020, adult patients with: (i) ≥1 prescription of etelcalcetide or cinacalcet, (ii) ≥3 hemodialysis/week, and (iii) without parathyroidectomy, were included. Based on the drug firstly prescribed, patients were allocated into etelcalcetide- and cinacalcet-treated cohorts, and the propensity score matching (PSM) methodology was applied to abate potential cohorts’ unbalances. Overall, 1752 cinacalcet- and 527 etelcalcetide-treated patients were enrolled. In cinacalcet- and etelcalcetide-treated patients, respectively, the most frequent comorbidities were hypertension (75.3% and 74.4%), diabetes mellitus (21.0% and 21.3%), and cardiovascular disease (18.1% and 13.3%, p < 0.01). In covariate-balanced cohorts, the treatment adherence and persistence rates were significantly higher in the etelcalcetide-treated (80.1% and 62.7%, respectively) vs. cinacalcet-treated cohort (62.3% and 54.7%, respectively). After PSM, the total costs for the management of cinacalcet- and etelcalcetide-treated patients, respectively, averaged EUR 23,480 and EUR 22,958, with the disease-specific drug costs (EUR 2629 vs. EUR 2355, p < 0.05) and disease-specific hospitalization costs (EUR 1241 vs. EUR 855) in cinacalcet- and etelcalcetide-treated patients. These results showed that, in etelcalcetide-treated patients, a higher treatment adherence and persistence was found, with disease-specific costs savings, especially those related to drugs and hospitalizations.
这项意大利真实世界数据分析评估了拟钙剂西那卡塞或依特卡肽的药物利用情况，以及慢性肾脏病（CKD）患者继发性甲状旁腺功能亢进（SHPT）的经济负担。在2010年1月1日至2020年6月30日期间，纳入了符合以下条件的成年患者：（i）至少有1次依特卡肽或西那卡塞处方；（ii）每周至少进行3次血液透析；（iii）未接受甲状旁腺切除术。根据首次开具的药物，将患者分为依特卡肽治疗组和西那卡塞治疗组，并应用倾向得分匹配（PSM）方法来减少潜在组间的不均衡。总体而言，共纳入了1752例接受西那卡塞治疗的患者和527例接受依特卡肽治疗的患者。在接受西那卡塞和依特卡肽治疗的患者中，最常见的合并症分别为高血压（75.3%和74.4%）、糖尿病（21.0%和21.3%）以及心血管疾病（18.1%和13.3%，p<0.01）。在协变量均衡的组中，依特卡肽治疗组的治疗依从率和持续率（分别为80.1%和62.7%）显著高于西那卡塞治疗组（分别为62.3%和54.7%）。经过PSM后，接受西那卡塞和依特卡肽治疗患者的管理总成本分别平均为23480欧元和22958欧元，其中接受西那卡塞和依特卡肽治疗患者的疾病特定药物成本（分别为2629欧元和2355欧元，p<0.05）以及疾病特定住院成本（分别为1241欧元和855欧元）存在差异。这些结果表明，在接受依特卡肽治疗的患者中，治疗依从性和持续率更高，且疾病特定成本有所节省，尤其是与药物和住院相关的成本。
