An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism—the German perspective

Schneider, R.; Kolios, George; Koch, Benjamin M.; Fernández, Emilio Domínguez; Bartsch, Detlef K.; Schlosser, Katja

doi:10.1016/j.surg.2010.09.009

Cited by 31 publications

(21 citation statements)

References 21 publications

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“…Observations from this study show a similar achievement of K/DOQI targets for serum calcium, phosphorus and CaxPO 4 product when parathyroidectomy and calcimimetics-based medical treatments are compared. However, several studies have claimed a superior cost effectiveness of parathyroidectomy over calcimimetics [16][17][18].…”

Section: Kdigomentioning

confidence: 99%

“…Currently, no studies exist that compare the long-term calcimimetic results to parathyroidectomy in dialysis patients with severe forms of SHPT. The higher cost of calcimimetis over surgical therapy [16], coupled with a lack of evidence regarding long-term superiority of calcimimetics-based medical therapy over parathyroidectomy in patients with uncontrolled SHPT, suggests that calcimimetics is the best option for patients on dialysis for a short period (less than 8 months) as well as for those who have a high mortality risk or patients expecting to receive a kidney transplant immediately [17]. Additionally, medical therapy could be more suitable if a patient's parathyroid glands are located in areas where resection is difficult (mediastinal gland), if the origin of excessive PTH secretion cannot be determined by diagnostic imaging and in cases of parathyroid carcinoma and parathyromathosis if the risk of significant surgical complications is high (repeated surgery and recurrent laryngeal nerve paralysis) [18].…”

Section: Introductionmentioning

confidence: 99%

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Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism

Kovačević

Ignjatović

Živaljević

et al. 2012

Langenbecks Arch Surg

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Section: Kdigomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism

Kovačević

Ignjatović

Živaljević

et al. 2012

Langenbecks Arch Surg

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“…However, the long-term superiority of calcimimetics-based medical therapy over PTX in dialysis patients with severe secondary HPT remains unclear. Only solid evidence for short-term use [15] and for those dialysis patients with refractory HPT intolerant to PTX [16] is available for the clinical use of cinacalcet. Therefore, PTX may continue to play an important role in dialysis patients with uncontrolled secondary HPT who cannot afford or otherwise obtain new therapeutics.…”

Section: Discussionmentioning

confidence: 99%

Short- and Long-Term Impact of Subtotal Parathyroidectomy on the Achievement of Bone and Mineral Parameters Recommended by Clinical Practice Guidelines in Dialysis Patients: A 12-Year Single-Center Experience

Tsai¹,

Peng²,

Yang³

et al. 2013

Blood Purif

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Background/Aims: The short- and long-term impact of parathyroidectomy (PTX) on the parameters of mineral bone disease in dialysis patients with severe secondary hyperparathyroidism (HPT) remains unclear. Methods: A retrospective chart review of 401 consecutive dialysis patients who underwent subtotal PTX by one surgeon was performed. We checked serum levels of calcium (Ca), phosphorus (P), and intact parathyroid hormone (iPTH) for 3 consecutive days, and then monthly for Ca, P, and tri-monthly for iPTH postoperatively. Patients with available laboratory data within the 1st to 6th postoperative months were included in the short-term follow-up group and those with at least 6 months available data were in the long-term follow-up one. Results: Patients (short-term group, n = 401, and long-term group, n = 94) had severely uncontrolled serum iPTH levels, Ca, P and Ca × P before PTX. In the short-term group, percentages of cases achieving K/DOQI targets for serum Ca, Ca × P, and iPTH and KDIGO ones for serum Ca, P, and iPTH after PTX, significantly improved compared with those before operation (all p < 0.05). In the long-term group (mean follow-up of 43 ± 29 months), the percentage of achieved targets for serum iPTH in both guidelines and for serum Ca and Ca × P in the K/DOQI recommendation also improved postoperatively (all p < 0.05). Conclusions: Achievements of K/DOQI recommended values for serum Ca, Ca × P, iPTH and KDIGO recommendations for iPTH can be successfully reached by subtotal PTX in medically refractory, secondary HPT in dialysis patients both during short- and long-term follow-ups.

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“…KBY'de paratiroidektomi operasyonu %10-30 hastaya uygulanıyor (27)(28)(29). Türk Nefroloji Derneği 2012 registry değerlerinde SHPT de ilaç kullanım oranlarına baktığımızda SHPT tanılı hastaların %46,36'sının tedavi aldığını tespit ettik.…”

Section: Bulgularunclassified

Cost Analysis between Operated Patients with Secondary Hyperparathyroidism and Patients Receiving Medical Treatment

Gürkan¹,

Sipahi²,

Tamer³

2015

Turk Neph Dial Transpl

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ÖzAmAç: Sekonder hiperparatiroidi (SHPT) kronik böbrek yetmezlikli (KBY) hastalarda yaygın bir bozukluktur. Medikal tedaviye dirençli hastalarda cerrahi tedavi uygulanmaktadır. Çalışmanın amacı, SHPT'li hastalar arasından hastanemizde paratiroidektomi operasyonu geçirmiş hastalar ile opere olmamış, medikal tedavi alan hastalar arasındaki yıllık ilaç tedavi maliyetlerini karşılaştırmaktır. Gereç ve YÖnTemler:Paratiroidektomi operasyonu geçiren SHPT'li 9 hasta retrospektif olarak değerlendirildi. Çalışmaya 9 erişkin hasta alındı. Demografik özellikleri benzer olan, medikal tedavi alan SPHT'li 9 hasta kontrol grubu olarak belirlendi. İki grubun ilaç maliyetleri Sosyal Güvenlik Kurumu (SGK) ilaç satış fiyatları üzerinden belirlenerek karşılaştırma yapıldı.BulGulAr: Paratiroidektomi operasyonu olan 9 hastanın operasyon öncesi PTH bazal değeri ortalaması 1919±594 pg/ml tespit edildi. İlaç tedavisi alan 9 hastanın PTH değeri ortalaması ise 1426±317 pg/ml idi. Operasyon sonrası yapılan takip sırasında hastalarımızdan iki tanesinde nüks gelişti. Yıllık ilaç maliyeti opere olan hastalarda ortalama 785±998 Türk Lirası (TL), opere olmayan hastalarda 3948±953 TL olarak tespit edildi. İki grup arasında maliyet açısından anlamlı farklılık bulundu (p<0,05).SOnuç: KBY'ne bağlı gelişen SHPT'li paratiroidektomi operasyonu olmuş hastalarda, operasyon sonrası yıllık ilaç maliyeti anlamlı oranda azalmaktadır. SPHT'li hastalarda tıbbi tedaviye yeterli cevap alınamadığında cerrahi tedaviye ilaç maliyetleri de göz önüne alınarak daha erken başvurulabilinir.AnAhTAr SÖzcükler: Kronik böbrek yetmezliği, Sekonder hiperparatiroidi, İlaç tedavisi, Paratiroidektomi, Tedavi maliyeti ABSTrAcT OBJecTIVe: Secondary hyperparathyroidism (SHPT) is a common disorder in patients with chronic renal failure (CRF). Surgical treatment is performed for patients resistant to medical treatment. The purpose of this study was to compare the costs of annual medication treatment between patients who had parathyroidectomy operation and unoperated patients. mATerIAl and meThODS: 9 patients with SHPT who had parathyroidectomy operations were evaluated retrospectively. 9 patients with SHPT with similar demographic characteristics who were receiving medical treatment were determined as the control group. Medication costs of two groups were specified and compared according to the sale prices of medications of Social Security Institution (SSI). reSulTS:The average PTH basal values of 9 patients who had parathyroidectomy operations were 1919±594 pg/ml before operation. Relapse developed in two patients. In the third year, the average PTH value of 9 patients receiving SHPT medication treatment was 1426±317 pg/ml. The annual medication cost was averagely 785±998 TRY for operated patients and 3948±953 TRY for unoperated patients. There was a significant difference between two groups in terms of cost (p<0.05).cOncluSIOn: Annual medication costs showed a significant decrease after operation. When sufficient response cannot be received to the treatment in patients with SHPT, s...

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An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism—the German perspective

Cited by 31 publications

References 21 publications

Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism

Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism

Short- and Long-Term Impact of Subtotal Parathyroidectomy on the Achievement of Bone and Mineral Parameters Recommended by Clinical Practice Guidelines in Dialysis Patients: A 12-Year Single-Center Experience

Cost Analysis between Operated Patients with Secondary Hyperparathyroidism and Patients Receiving Medical Treatment

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