Hospital das Clínicas da Faculdade de Medicina de Botucatu, Departamento de Gestão de Atividades Acadêmicas, Núcleo de Avaliação de Tecnologia em Saúde, Botucatu, SP, Brazil.
Ministério da Saúde, Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde, Brasília, DF, Brazil.
J Bras Nefrol. 2023 Jan-Mar;45(1):95-101. doi: 10.1590/2175-8239-JBN-2022-0049en.
Hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD) is characterized by high levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands and cardiovascular disease. Selective and non-selective and selective vitamin D-receptor activators, calcimimetics, are available in the Brazilian market to reduce PTH levels.
To develop a cost-effectiveness (C/E) and budgetary impact (BI) analysis of intravenous paricalcitol vs. oral calcitriol for patients on dialysis with SHPT, from the perspective of the Brazilian Public Health Care System (SUS).
We built a decision-tree model to analyze C/E, which considered the outcome of avoided death and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of demand and one of epidemiological approach, based on data from the Brazilian Society of Nephrology.
The analysis showed that the C/E ratio was R$ 1,213.68 per year, and an incremental effectiveness of 0.032, referring to avoided death. The incremental C/E ratio was R$37,927.50 per death averted by paricalcitol. It was estimated that the incremental BI with the expansion of paricalcitol use will be between R$1,600,202.28 and R$4,128,565.65 in the first year, considering the main and epidemiological scenarios. At the end of 5 years after the expansion of its use, an incremental BI was estimated between R$ 48,596,855.50 and R$ 62,90,555.73.
Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost.
慢性肾脏病（CKD）继发甲状旁腺功能亢进症（SHPT）的特征是甲状旁腺激素（PTH）水平升高、甲状旁腺增生和心血管疾病。目前巴西市场上有选择性和非选择性维生素 D 受体激动剂、钙敏感受体激动剂，用于降低 PTH 水平。
从巴西公共医疗保健系统（SUS）的角度出发，为透析并发 SHPT 的患者开发静脉用帕立骨化醇与口服骨化三醇的成本效益（C/E）和预算影响（BI）分析。
我们构建了一个决策树模型来分析 C/E，该模型考虑了避免死亡的结果和 1 年的时间范围。对于 BI 分析，我们考虑了两种情况，一种是基于巴西肾病学会数据的需求情况，另一种是流行病学方法情况。
分析表明，C/E 比为每年 1213.68 雷亚尔，增量有效性为 0.032，即避免死亡。帕立骨化醇每避免一例死亡的增量 C/E 比为 37927.50 雷亚尔。预计在帕立骨化醇使用扩大的情况下，第一年的增量 BI 将在 1600202.28 雷亚尔至 4128565.65 雷亚尔之间，考虑到主要和流行病学情况。在帕立骨化醇使用扩大后的 5 年内，预计增量 BI 为 48596855.50 雷亚尔至 62905555.73 雷亚尔之间。
与口服骨化三醇相比，静脉用帕立骨化醇具有更好的疗效和相似的安全性，可以降低透析患者的整体死亡率，尽管它的成本更高。
