Cost-effectiveness analysis of intravenous paricalcitol vs. oral calcitriol in the treatment of hyperparathyroidism secondary to chronic kidney disease

Abstract Introduction: 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. Objectives: 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). Methodology: 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. Results: 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. Conclusion: Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost.

摘要
引言：继发性甲状旁腺功能亢进（SHPT），源于慢性肾脏病（CKD），其主要特征为高浓度的甲状旁腺激素（PTH）、甲状旁腺的增生以及心血管疾病。巴西市场已提供选择性及非选择性维生素D受体激活剂、钙敏素等药物，以降低PTH水平。目标：旨在从巴西公共卫生保健系统（SUS）的角度，开展静脉注射帕立钙素与口服钙化醇在维持透析治疗SHPT患者中的成本效益（C/E）及预算影响（BI）分析。方法：构建决策树模型以分析C/E，考虑了避免死亡的结果以及1年的时间跨度。对于BI分析，考虑了两种情景，一种为需求情景，另一种为流行病学方法，数据来源于巴西肾脏病学会。结果：分析显示，C/E比率为每年R$1,213.68，避免死亡的有效性增量约为0.032。通过帕立钙素避免死亡，增量C/E比率为每死亡一人R$37,927.50。预计随着帕立钙素使用范围的扩大，第一年的增量BI将在R$1,600,202.28至R$4,128,565.65之间，考虑主要情景和流行病学情景。在使用范围扩大的5年后，预计增量BI将在R$ 48,596,855.50至R$ 62,90,555.73之间。结论：静脉注射帕立钙素在疗效上优于口服钙化醇，且安全性相当，能够降低透析患者的整体死亡率，尽管其成本相对较高。