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Spanish economics study supports early initiation of SHPT treatment

17 January 2022

Researchers highlight the economic burden of SHPT and the cost benefits of preventing its development through early management

A team of health economists has analysed the difference in healthcare costs between chronic kidney disease (CKD) patients with and without secondary hyperparathyroidism (SHPT) in Spain.1 The study’s findings provide economic support for the clinical opinion that SHPT should be treated early in the course of CKD to reduce the risks of developing complications and therapeutic resistance.1–5

Study goal

The main goal of the analysis was to investigate the economic burden of SHPT in Spain by quantifying and comparing the utilisation of healthcare resources by CKD patients with and without SHPT.1 The study focused on the costs of:1

  • Pharmacological treatments
  • Hospitalisations and procedures associated with cardiovascular events (CVEs) attributable to SHPT

The study also sought to explore the differences in costs after stratifying by dialysis, hypercalcaemia or hyperphosphataemia, as the latter two are associated with common SHPT treatments (active vitamin D [AVD] and its analogues).1,6–9

Study design

Data for the analysis came from NEFRONA, a prospective multicentre observational study in which 2,445 CKD patients were enrolled in 81 Spanish hospitals and dialysis clinics from 2009 to 2012.1 The patients had been followed for 2 years for CKD progression and for 4 years for the incidence of CVEs.1

For the current analysis, all patients were stratified by presence of SHPT, which was defined as either one of the following:1

  • A parathyroid hormone (PTH) level over the guidelines recommended by the Kidney Disease Outcomes Quality Initiative (KDOQI)*
  • Treatment with PTH-reducing agents, such as AVD compounds or cinacalcet

To ascertain treatment costs, the dosage for each treatment regimen was assumed based on guidelines and multiplied by the official unit cost, which was obtained from BOT PLUS, the official drugs database of the General Council of the Official College of Pharmacists in Spain.1 The costs of CVE-related hospitalisations and procedures were obtained from hospital discharge records.1

Study results

The prevalence of SHPT in the NEFRONA cohort was 65.6%.1

Before stratifying by dialysis, hypercalcaemia or hyperphosphataemia, the average annual cost of treatment for CKD patients with SHPT was 143.0% higher than it was for CKD patients without SHPT (Table 1).1

Table 1. Average annual costs (€) of treatment for CKD patients with and without SHPT1
graph

Adapted from Alonso-Perez E et al. 2021.1

After stratifying by dialysis, hypercalcaemia or hyperphosphataemia, the cost of treatment was always higher for the patients with SHPT than it was for the patients without SHPT (Figure 1).1

Figure 1. Average annual costs (€) of treatment for patients with and without SHPT after stratifying by dialysis, hypercalcaemia or hyperphosphataemia1
graph

The treatments included antidiabetics, statins, antihypertensives and bone and mineral metabolism (BMM) treatments, such as AVD analogues, calcimimetics and phosphate binders. The majority of the cost in each group came from BMM treatments.

Adapted from Alonso-Perez E et al. 2021.1

CVEs were experienced by 203 patients, resulting in 4-year average costs of €582.57 for non-SHPT patients and €941.87 for SHPT patients (61.7% average increase).1

After stratifying by dialysis, hypercalcaemia or hyperphosphataemia, the cost associated with CVEs was always higher for patients with SHPT than it was for patients without SHPT.1

Key takeaways

  • The costs of pharmacological treatments and CVEs for CKD patients with SHPT are substantially higher than they are for CKD patients without SHPT1
  • Preventing the development and progression of SHPT by treating it early in the course of CKD could potentially lead to better patient outcomes and less economic burden on healthcare systems1

Read the full paper now

The Spanish health economics analysis was published in September 2021 in the journal Advances in Therapy. You can read the full publication now on the Springer website.

Footnotes and references

*SHPT in stage 3 CKD was defined as PTH >70 pg/mL (>7.4 pmol/L), in stage 4 as >110 pg/mL (>11.7 pmol/L) and in stage 5 or dialysis as >300 pg/mL (>31.8 pmol/L).10

  1. Alonso-Perez E et al. Adv Ther. 2021;38:5333–44.

  2. Locatelli F et al. Nephrol Dial Transplant. 2002;17:723–31.

  3. Tomasello S. Diabetes Spectr. 2008;21:19–25.

  4. Tabibzadeh N et al. Nephrol Dial Transplant. 2021;36(1):160–9.

  5. Xu Y et al. Clin Kidney J. 2021;14(10):2213–20.

  6. Goodman WG et al. Kidney Int. 1994;46(4):1160–6.

  7. Przedlacki J et al. Nephron. 1995;69:433–7.

  8. Coyne DW et al. Nephrol Dial Transplant. 2013;28:2260–8.

  9. Coyne DW et al. Clin J Am Soc Nephrol. 2014;9:1620–6.

  10. National Kidney Foundation. Am J Kidney Dis. 2003;42(4 Suppl 3):S1–201.