Health-Economic Comparison of Paricalcitol, Calcitriol and Alfacalcidol for the Treatment of Secondary Hyperparathyroidism during Haemodialysis

Abstract

This study evaluated the health-economic consequences of use of intravenous paricalcitol (Zemplar), oral calcitriol or oral and intravenous alfacalcidol for the treatment of patients with secondary hyperparathyroidism, focusing on a third-party payer perspective through inclusion of medication and hospital costs, survival rates and utilities. Cost values were based on German treatment recommendations and prices. Reference values for survival rates and utilities were based on the results of a MEDLINE search. The analysis showed a clear advantage for intravenous paricalcitol with respect to costs, effectiveness and utilities compared with treatment with oral calcitriol or intravenous alfacalcidol. Since the results were very cost sensitive with respect to selected diagnosis-related groups (DRGs) for kidney disease with dialysis, a sensitivity analysis was performed. This demonstrated first-order dominance of intravenous paricalcitol for a wide range of hospitalisation costs. In conclusion, this analysis suggested a clear benefit from the perspective of a third-party payer for intravenous paricalcitol compared with oral calcitriol and intravenous alfacalcidol in the treatment of patients with secondary hyperparathyroidism.

Which Vitamin D in CKD-MBD? The Time of Burning Questions

“…Similar trends are reported by the United Renal Data System between 1999 and 2008, with a declined use of intravenous calcitriol from 83.9% to 1.8%, accompanied by a raise in paricalcitol and doxercalciferol intravenous adoption [91]. Health-economic analysis observed that paricalcitol may have potential economic benefits in both CKD and dialysis patients compared to calcitriol and alfacalcidol [92, 93]. Furthermore, a recent economic analysis of the FARO survey observed that intravenous paricalcitol was more cost-effetctive compared to the combination of paricalcitol plus cinacalcet [94].…”

Association of Secondary Hyperparathyroidism with CKD Progression, Health Care Costs and Survival in Diabetic Predialysis CKD Patients

“…Our study demonstrates the economic burden of SHPT in diabetic predialysis CKD patients and the negative impact on disease progression. Previous studies have shown the economic advantage and improvement in survival of selective VDRA therapy in CKD stage 5 hemodialysis patients [14,15,16,17,18]. Further analyses are needed to assess whether early treatment with a selective VDRA in diabetic predialysis CKD patients can reduce such excessively high costs and positively impact the disease progression and clinical outcomes including survival.…”

Vitamin D receptor activation and survival in chronic kidney disease

“…71 This may be one of the reasons why a cost analysis suggested that the use of paricalcitol provided cost-savings compared with calcitriol, in spite of its higher price. 72,73 Limitations inherent of observational data apply to these studies as well, and short of an RCT their results can also be only viewed as hypothesis-generating.…”