NDT Advance Access originally published online on February 17, 2007
Nephrology Dialysis Transplantation 2007 22(5):1428-1436; doi:10.1093/ndt/gfl774
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The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective
1Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Exeter and Plymouth, England and 2Royal Devon and Exeter Hospital, Exeter, UK
Correspondence and offprint requests to: Ruth Garside, Peninsula Technology Assessment Group, Peninsula Medical School, Noy Scott House, Royal Devon & Exeter Hospital, Barrack Road Exeter, EX2 5DW, UK. Email: Ruth.Garside{at}PenTAG.nhs.uk
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Abstract |
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Background. Secondary hyperparathyroidism (SHPT) is a common side effect of end-stage renal disease (ESRD) and is associated with increased risk of fracture and cardiovascular events (CV). Current standard treatment includes dietary control, phosphate binders and vitamin D. However, many patients do not have their parathyroid hormone (PTH), calcium and phosphate levels controlled by this regimen. Cinacalcet is the first of a new class of calcimimetic drugs which suppress PTH production. Although there is convincing evidence of the impact of cinacalcet on serum biomarkers, the long-term clinical implications of treatment are less clear. The aim of this study is to estimate the cost-utility of cinacalcet as an addition to standard treatment of SHPT compared with standard treatment alone.
Methods. A Markov model was developed to estimate the incremental cost-utility of cinacalcet. Uncertainty was explored through extensive sensitivity analysis.
Results. Compared with standard treatment, cinacalcet incurs average additional lifetime costs of £21 167 per person and confers an additional 0.34 quality adjusted life years, resulting in an incremental cost-effectiveness ratio of £61 890 (approximately 
89 000) per quality-adjusted life-year (QALY). Extensive one-way sensitivity analysis showed that cinacalcet was only likely to be considered cost-effective if the relative risk of mortality for people with very high levels of PTH was 2.2 compared with people whose PTH reached target levels, or if drug costs were considerably reduced. Probabilistic sensitivity analysis showed cinacalcet was very unlikely to be cost-effective at usual levels of willingness to pay in the National Health Service (NHS).
Conclusion. Unless the cost of cinacalcet is considerably reduced, it is unlikely to be considered a cost-effective treatment for people with SHPT.
Keywords: cinacalcet; cost-effectiveness; cost-utility; end-stage renal disease; modelling studies; secondary hyperparathyroidism
Received for publication: 24. 7.06
Accepted in revised form: 29.11.06
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