Impact of mineral and bone disorder on healthcare resource use and associated costs in the European Fresenius medical care dialysis population: a retrospective cohort study

Abstract

BackgroundSecondary hyperparathyroidism (SHPT) is associated with mortality in patients with chronic kidney disease (CKD), but the economic consequences of SHPT have not been adequately studied in the European population. We assessed the relationship between SHPT parameters (intact parathyroid hormone [iPTH], calcium, and phosphate) and hospitalisations, medication use, and associated costs among CKD patients in Europe.MethodsThe analysis of this retrospective cohort study used records of randomly selected patients who underwent haemodialysis between January 1, 2005 and December 31, 2006 at participating European Fresenius Medical Care facilities in 10 countries. Patients had ≥ 1 iPTH value recorded, and ≥ 1 month of follow-up after a 3-month baseline period during which SHPT parameters were assessed. Time at risk was post-baseline until death, successful renal transplantation, loss to follow-up, or the end of follow-up. Outcomes included cost per patient-month, rates of hospitalisations (cardiovascular disease [CVD], fractures, and parathyroidectomy [PTX]), and use of SHPT-, diabetes-, and CVD-related medications. National costs were applied to hospitalisations and medication use. Generalised linear models compared costs across strata of iPTH, total calcium, and phosphate, adjusting for baseline covariates.ResultsThere were 6369 patients included in the analysis. Mean ± SD person-time at risk was 13.1 ± 6.4 months. Patients with iPTH > 600 pg/mL had a higher hospitalisation rate than those with lower iPTH. Hospitalisation rates varied little across calcium and phosphate levels. SHPT-related medication use varied with iPTH, calcium, and phosphate. After adjusting for demographic and clinical variables, patients with baseline iPTH > 600 pg/mL had 41% (95% CI: 25%, 59%) higher monthly total healthcare costs compared with those with iPTH in the K/DOQI target range (150–300 pg/mL). Patients with baseline phosphate and total calcium levels above target ranges (1.13–1.78 mmol/L and 2.10–2.37 mmol/L, respectively) had 38% (95% CI: 27%, 50%) and 8% (95% CI: 0%, 17%) higher adjusted monthly costs, respectively. Adjusted costs were 25% (95% CI: 18%, 32%) lower among patients with baseline phosphate levels below the target range. Results were consistent in sensitivity analyses.ConclusionsThese data suggest that elevated SHPT parameters increase the economic burden of CKD in Europe.

Evaluating targets and costs of treatment for secondary hyperparathyroidism in incident dialysis patients: the FARO-2 study

“…This study highlights that costs related to health care resource utilization, as already reported in a European Union study 20 and a US study, 21 increased with rising baseline PTH. Confirming the findings of the cost consequences analysis of the FARO survey 22 performed on the overall hemodialysis population, the present study showed that different baseline severity of SHPT in terms of PTH level was associated with different treatment patterns.…”

Systematic review of surgical and medical treatment for tertiary hyperparathyroidism

“…Finally, cost‐effectiveness remains an important consideration in the choice of treatment. Uncontrolled HPT increases the economic burden of patients with secondary HPT undergoing dialysis owing to higher medication and hospitalization costs. Compared with cinacalcet treatment, parathyroidectomy is more cost‐effective in these patients, mainly due to the significant additional cost and chronic use of cinacalcet.…”

Metabolismo mineral óseo en pacientes con enfermedad renal crónica: revisión sobre su fisiopatología y morbimortalidad

“…Asimismo pacientes con valores de calcio y fósforo por encima del rango normal también tuvieron incremento en el costo mensual por paciente (51) .…”