| Background and objective:Secondary hyperparathyroidism(SHPT)seriously affects the survival prognosis of patients with chronic kidney disease.This study assessed the cost-effectiveness and cost-utility of parathyroidectomy(PTx)for the the treatment of SHPT in dialysis patients compared with and the cinacalcet.To analysis economic feasibility and merits for clinical decision-making.Methods:(1)We conducted a retrospective study to evaluate treatment with cinacalcet and PTx in dialysis patients with SHPT,and made the baseline value comparable between the two groups;(2)The retrospective survey was to extract the patient follow-up database;(3)The cross-sectional survey with questionnaire for the data about costs.health-related quality of life and et;(4)The basic information between two groups of patients were analyzed by T test,Chi-square test,rank test,and the preliminary analysis results were obtained;(5)We developed a probabilistic tree model to simulate the effect of cinacalcet and PTx on PTH levels and its complications in SHPT,based on data from relevant literature and clinical data.Cost-effectiveness analysis were carried out by using rollback analysis,incremental analysis;(6)We applied the Tornado diagramsn and Monte Carlo Simulation for sensitivity analysis;(7)Excel2016,SPSS24.0 and TreeAge2016 software for data collation and analysis.Results:(1)The basic situation:a total of 82 dialysis patients were enrolled(41 subjects in Cinacalcet group and 41 subjects in PTx group).Most of the data have no statistical difference(P>0.05)except for the gender factor;(2)The efficacy:there are statistically significant between two groups in the aspect of one year after treatment serum calcium(P = 0.002),6 months of P(P = 0.037)and serum iPTH after treatment(P<0.05);PTx overall treatment effectiveness(85.4%)is higher than cinacalcet therapy(63.4%)and has statistically significant(P = 0.04);We finally used Chinese measure to calculate the health utility;(3)The economic evaluation:the total cost of treatment on PTx a year(153800 yuan)is slightly higher than the cinacalcet(149600 yuan),the cost-effectiveness ratio of PTx(180110 yuan)is below the cinacalcet(236030 yuan),and the incremental analysis shows that every one case of successful treatment of PTx with SHPT patients a year corresponding increase in the cost of 18980yuan,the sensitivity analysis shows that cost-effectiveness(utility)gap increases with the willingness to pay,and the research conclusion is stability.Conclusion:(1)the PTx and the cinacalcet effectively controlld the biochemical indicators for SHPT,and overall efficiency of the PTx is superior to cinacalcet and has obvious advantages;(2)the cinacalcet’s total cost is lower than the PTx,but long-term results are reversed;(3)the efficacy of PTx has cost-effectiveness advantages but only in the pathway of events with uncontrolled Ca and P has no cost-effectiveness advantages;(4)a sensitivity analysis shows that costs of uncontrollable cinacalcet group without events(CCNU)and efficacy of uncontrollable PTx group without events(EPNU)are the main factors which influence the evaluation results;(5)the Monte Carlo simulation results show that the research on cost-effectiveness are stability and have high credibility.(6)In addition,this study has some limitations on sample size and the research time cycle,hope to have a higher quality of research data to support the above conclusion.Suggestion:This study suggests that the actual clinical decision-making reference to the results of this economic evaluation,according to the different needs of different patients personalized selection,at the same time actively promote the two treatment programs in the application of SHPT treatment.Clinical practice should be done early detection,early diagnosis,early treatment,in order to improve the quality of life of patients with SHPT. |
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