The study addresses the challenge of treating secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, focusing on the cost-effectiveness of surgical versus pharmacological interventions. Conducting a retrospective analysis on 152 CKD patients with SHPT at the Third People's Hospital of Chengdu, the study matched 80 patients into two groups: 40 undergoing parathyroidectomy with autotransplantation (PTX + AT) and 40 treated with calcimimetics. PTX + AT was more effective in alleviating symptoms, particularly bodily pain, and demonstrated greater cost-effectiveness over a long-term period compared to calcimimetics. This was especially significant in patients with PTH levels > 1800 pg/mL and hyperphosphatemia. Despite similar initial costs, PTX + AT led to a substantial decrease in expenses during the 2–5 years post-treatment period, PTX + AT results in an ICER of -RMB 26.71/QALY for the first post-treatment year and -RMB-111.9k/QALY for the 2–5 year period, indicating cost-effectiveness with reduced long-term costs. The study also found an increased economic burden in managing patients with hyperphosphatemia. Surgical intervention (PTX + AT) is advocated as the primary treatment strategy for severe SHPT in CKD patients, owing to its long-term economic and clinical advantages. The results underscore the need for a severity-based approach in treating SHPT.

该研究解决了治疗慢性肾脏病（CKD）患者继发性甲状旁腺功能亢进症（SHPT）的挑战，重点关注手术与药物干预的成本效益。该研究对成都市第三人民医院 152 例患有 SHPT 的 CKD 患者进行回顾性分析，将 80 例患者分为两组：40 例接受甲状旁腺切除联合自体移植（PTX + AT），40 例接受拟钙剂治疗。与拟钙剂相比，PTX + AT 在缓解症状（尤其是身体疼痛）方面更有效，并且在长期内表现出更高的成本效益。这对于 PTH 水平 > 1800 pg/mL 和高磷血症的患者尤其重要。尽管初始成本相似，PTX + AT 导致治疗后 2-5 年期间的费用大幅下降，PTX + AT 导致治疗后第一年的 ICER 为 -RMB 26.71/QALY，并且 -RMB- 2-5 年期间为 111.9k/QALY，表明长期成本降低的成本效益。该研究还发现管理高磷血症患者的经济负担增加。手术干预（PTX + AT）因其长期的经济和临床优势而被提倡作为 CKD 患者严重 SHPT 的主要治疗策略。结果强调需要采用基于严重程度的方法来治疗 SHPT。