Skip to main content

Advertisement

SpringerLink
Log in

Cost-Effectiveness and Clinical Outcomes of Secondary Hyperparathyroidism Treatments in Patients with Chronic Kidney Disease

  • Original Research
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

References

  1. Shireman TI, Almehmi A, Wetmore JB, Lu J et al (2010) Economic analysis of cinacalcet in combination with low-dose vitamin D versus flexible-dose vitamin D in treating secondary hyperparathyroidism in hemodialysis patients. Am J Kidney Dis 56(6):1108–1116. https://doi.org/10.1053/j.ajkd.2010.07.012

    Article  CAS  PubMed  Google Scholar 

  2. Belozeroff V, Lee A, Tseng S et al (2013) Cost per responder analysis in patients with secondary hyperparathyroidism on dialysis treated with cinacalcet. J Med Econ 16(9):1154–1162. https://doi.org/10.3111/13696998.2013.826665

    Article  PubMed  Google Scholar 

  3. Bellorin-Font E, Vasquez-Rios G, Martin KJ (2019) Controversies in the Management of Secondary Hyperparathyroidism in Chronic Kidney Disease. Curr Osteoporos Rep 17(5):333–342. https://doi.org/10.1007/s11914-019-00533-x

    Article  PubMed  Google Scholar 

  4. Barbuto S, Perrone V, Veronesi C et al (2023) Real-world analysis of outcomes and economic burden in patients with chronic kidney disease with and without secondary hyperparathyroidism among a sample of the Italian population. Nutrients 15(2):336. https://doi.org/10.3390/nu15020336

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Evenepoel P, Jørgensen HS (2022) Parathyroidectomy versus calcimimetic: the lower the PTH the better? J Clin Endocrinol Metab 107(8):e3532–e3533. https://doi.org/10.1210/clinem/dgac211

    Article  PubMed  PubMed Central  Google Scholar 

  6. Rroji M, Spasovski G (2018) Calcimimetics versus parathyroidectomy: what is preferable? Int Urol Nephrol 50(7):1271–1275.https://doi.org/10.1007/s11255-018-1838-5

    Article  CAS  PubMed  Google Scholar 

  7. Schneider R, Kolios G, Koch BM et al (2010) An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism–the German perspective. Surgery 148(6):1091–1099. https://doi.org/10.1016/j.surg.2010.09.009

    Article  PubMed  Google Scholar 

  8. Lorenz K, Bartsch DK, Sancho JJ et al (2015) Surgical management of secondary hyperparathyroidism in chronic kidney disease–a consensus report of the European Society of endocrine surgeons. Langenbecks Arch Surg 400(8):907–927. https://doi.org/10.1007/s00423-015-1344-5

    Article  PubMed  Google Scholar 

  9. Long AN, Dagogo-Jack S (2011) Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens (Greenwich) 13(4):244–251. https://doi.org/10.1111/j.1751-7176.2011.00434.x

    Article  PubMed  Google Scholar 

  10. Komaba H, Fukagawa M (2018) Secondary hyperparathyroidism and protein-energy wasting in end-stage renal disease. Ther Apher Dial 22(3):246–250. https://doi.org/10.1111/1744-9987.12683

    Article  PubMed  Google Scholar 

  11. Danese MD, Belozeroff V, Smirnakis K et al (2008) Consistent control of mineral and bone disorder in incident hemodialysis patients. Clin J Am Soc Nephrol 3(5):1423–9. https://doi.org/10.2215/CJN.01060308

    Article  PubMed  PubMed Central  Google Scholar 

  12. Slinin Y, Guo H, Gilbertson DT et al (2011) Prehemodialysis care by dietitians and first-year mortality after initiation of hemodialysis. Am J Kidney Dis 58(4):583–90. https://doi.org/10.1053/j.ajkd.2011.03.032

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding.

Author information

Author notes

  1. Wenjie Zhang and Hailiang Ren shares equal contribution.

Authors and Affiliations

  1. The Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu and The Affiliated Hospital of Southwest Jiaotong University, No. 19 Yangshi Road, Chengdu, 610031, China

    Wenjie Zhang & Jian Wu

  2. Department of Gastrointestinal, Bariatric and Metabolic Surgery, and Research Center for Nutrition, Metabolism and Food Safety, West China School of Public Health and West China Fourth Hospital, West China-PUMC CC.C. Chen Institute of Health, Sichuan University, Chengdu, 610000, China

    Hailiang Ren

  3. Department of Laboratory Medicine, Chengdu First People’s Hospital, Chengdu, 610041, Sichuan, China

    Qianxiu Liao

Authors
  1. Wenjie Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hailiang Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qianxiu Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jian Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

WenJie Zhang: Formal analysis, Investigation, Methodology, Writing—original draft, Jian Wu: Conceptualization, Writing—review & editing, Hailiang Ren: Data curation, Software, Qianxiu Liao: Data curation, Investigation.

Corresponding author

Correspondence to Jian Wu.

Ethics declarations

Conflict of interest

No financial conflicts of interest were reported by the authors WenJie Zhang, Hailiang Ren,Qianxiu Liao,Jian Wu.

Human and Animal Rights and Informed Consent

This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All procedures performed in this study involving human participants were in line with the ethical standards of the institutional research committee at the Third Hospital of Chengdu and the national research council. Informed consent was obtained from all individual participants involved in the study. Participant data were de-identified and confidentiality was ensured throughout the study and subsequent data analysis process.This study did not involve any animals.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, W., Ren, H., Liao, Q. et al. Cost-Effectiveness and Clinical Outcomes of Secondary Hyperparathyroidism Treatments in Patients with Chronic Kidney Disease. Calcif Tissue Int 114, 368–376 (2024). https://doi.org/10.1007/s00223-024-01187-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-024-01187-3

Keywords

Search

Navigation