Paricalcitol vs Cinacalcet in the Treatment of Chronic Kidney Disease in Patients with Secondary Hyperthyroidism: A Markov Cost-Effectiveness Model

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Chronic kidney disease is one of the fastest-growing diseases in the United States, affecting over 35 million people. A major complication of end-stage kidney disease (ESKD) is secondary hyperthyroidism (SHPT). Multiple treatments are currently approved for ESKD patients with SHPT, including paricalcitol and cinacalcet. Previous studies have shown paricalcitol to be the cost-effective option, however, these studies are either not US based or do not include all hospitalization costs. The objective of this study was to determine if paricalcitol is cost-effective compared to cinacalcet in the treatment of ESKD patients with SHPT from a US healthcare-based perspective. A Markov model was used to determine the cost-effectiveness over a 10-year timeframe, using a 3% discount for costs and utilities. Health states included hemodialysis, peritoneal dialysis, kidney transplant, kidney transplant accepted, and death, with associated costs for each health state, treatments, and hospitalizations being used in the model. The base-case results produced an incremental cost-effectiveness ratio (ICER) of $1,110,919 for paricalcitol compared to cinacalcet. A one-way sensitivity analysis was conducted and found no parameters individually changed the ICER significantly. Probabilistic sensitivity analysis utilized 10,000 simulations to determine the cost-effectiveness acceptability at different willingness-to-pay thresholds. The sensitivity analysis resulted in a wide range of incremental costs and incremental utilities, with slight differences in base case parameters having wide effects over the 10-year time frame. Few simulations resulted in paricalcitol being accepted at willingness-to-pay thresholds ranging from $500-$100,000. Even though the sensitivity analysis resulted in a wide range of results, paricalcitol is not cost-effective compared to cinacalcet in the treatment of ESKD patients with SHPT. Further studies should be conducted as this result goes against the results of studies in the past. With the high costs and low utility gains, emphasis should remain on preventing patients from developing ESKD.



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