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NDT Advance Access originally published online on December 8, 2007
Nephrology Dialysis Transplantation 2008 23(4):1460; doi:10.1093/ndt/gfm747
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Cinacalcet: benefit and cost

E-mail: ecohen{at}mcw.edu

Sir,

Fukagawa et al. have confirmed the efficacy of cinacalcet in reducing the serum concentrations of parathyroid hormone (PTH) in long-term dialysis patients [1]. Their paper leaves some questions unanswered. Notably, one can legitimately question whether the expense of cinacalcet is worthwhile [2,3].

But, if the use of cinacalcet leads to improved quality or quantity of life, then this drug may indeed be useful for chronic dialysis patients. However, the data presented in this paper do not appear to show better quality or quantity of life in those on cinacalcet. In fact, there was a greater occurrence of nausea in those on cinacalcet compared to placebo.

Leaving expense and quality of life aside, if cinacalcet could provide a ‘medical’ parathyroidectomy, then it might have some use. Considering the vintage of the subjects in this paper, one might expect a substantial occurrence rate of parathyroidectomy in subjects on long-term dialysis for 7 years [4]. But there do not appear to be data on parathyroidectomy rates in the present paper by Fukagawa et al. Perhaps longer follow-up may show such an effect of cinacalcet. Even if it did, quality of life and survival data would be very important in deciding on the cost–benefit ratio of this expensive medication.

Conflict of interest statement. None declared.

Eric Cohen

Medical College of Wisconsin Milwaukee, WI, USA

References

  1. Fukagawa M, Yumita S, Akizawa T, et al. Cinacalcet (KRN1493) effectively decreases the serum intact PTH level with favorable control of the serum phosphorus and calcium levels in Japanese dialysis patients. Nephrol Dial Transplant (2007) in press.
  2. Garside R, Pitt M, Anderson R, et al. 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. Nephrol Dial Transplant (2007) 22:1428–1436.[Abstract/Free Full Text]
  3. Cohen EP, Uribarri J. Cinacalcet: a cost commentary. Semin Dial (2005) 18:353–354.[CrossRef][Web of Science][Medline]
  4. Cohen EP. Reduction in use of parathyroidectomy. J Am Soc Nephrol (2003) 14:684a.

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
23/4/1460    most recent
gfm747v1
Right arrow Alert me when this article is cited
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Right arrow Email this article to a friend
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Right arrow Download to citation manager
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Right arrow Articles by Cohen, E.
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Right arrow PubMed Citation
Right arrow Articles by Cohen, E.
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