Health-Economic Comparison of Paricalcitol, Calcitriol and Alfacalcidol for the Treatment of Secondary Hyperparathyroidism during Haemodialysis

Hubertus Rosery; Rito Bergemann; Steven E. Marx; Axel Boehnke; Joel Melnick; Raimund Sterz; Laura Williams


Clin Drug Invest. 2006;26(11):629-638. 

In This Article

3. Results

3.1 Cost-Consequence Analysis

The medication costs of vitamin D therapy differed with respect to the type of administration (intravenous vs oral). While treatment with capsules was associated with mean yearly costs of €375 (Eins Alpha®, Bocatriol®, Calcitriol-Nephro® and Decostriol®), intravenous treatment was associated with yearly costs of €2478 for alfacalcidol (Eins Alpha®) and €3979 for paricalcitol (Zemplar®) [see Table I ].

The incremental number of hospitalisation admissions per year was 0.846 fewer for patients who started and remained on intravenous paricalcitol than for patients being treated with calcitriol.[22] These fewer hospitalisations led to cost savings of €5394 associated with the use of intravenous paricalcitol versus calcitriol (0.846 fewer hospital admissions per year multiplied by €6376 per hospital admission). Overall cost savings totalled €1790–€1886 (i.e. €3979 - [€375–€471] - €5394) per year. On the basis of these calculations, use of intravenous paricalcitol compared with intravenous alfacalcidol was associated with cost savings of €3893 per year per patient treated for secondary hyperparathyroidism (i.e. €3979 - €2478 - €5394).

3.2 Cost-Effectiveness Analysis

The cost-effectiveness analysis was based on 1-year survival rates with paricalcitol (0.84) and calcitriol (0.80), as reported in the study by Teng et al.[23] On the basis of the medication and hospitalisation cost assumptions outlined, paricalcitol demonstrated first-order dominance over intravenous alfacalcidol, with cost savings of €3893 and 0.04 incremental life-years saved.

3.3 Cost-Utility Analysis

Utilities scores were calculated by multiplying the probabilities of hospitalisations, survival rates and utility associated with hospitalisation versus non-hospitalisation. Utility scores were totalled for each medicinal therapy and are presented in figure 1.

The sum of the utility scores for each treatment strategyresultedinaquality-adjustedlife-year (QALY) score of 0.378336 for paricalcitol and 0.34784 for calcitriol. Thus, intravenous paricalcitol was associated with an increase of 0.030 QALYs compared with oral calcitriol. When only medication costs were considered, the incremental costs for one additional QALY were estimated to be €118179 (€3979 - €375)/0.030496 QALYs) for intravenous paricalcitol compared with oral calcitriol. Inclusion of cost savings associated with decreased number of hospitalisations demonstrated first-order dominance of intravenous paricalcitol (compared with both oral calcitriol and intravenous alfacalcidol treatments).

3.4 Sensitivity Analysis

A sensitivity analysis was conducted to assess the impact of variables with the greatest uncertainty: hospitalisation costs and utilities. Hospitalisation costs were based on G-DRG L60A or G-DRG L60C (see Table II ). Varying the hospitalisation costs between €4290 and €8728 resulted in extremes of an incremental total cost savings of €25 and €5883 with intravenous paricalcitol (see Table IV ) compared with oral calcitriol and intravenous alfacalcidol, respectively.

The utility score that was used in the cost-utility analysis for end-stage renal disease non-hospitalised patients with secondary hyperparathyroidism was selected on the basis of a range of published utility scores for end-stage renal disease and haemodialysis, together with the typical signs and symptoms associated with secondary hyperparathyroidism. Since we were uncertain of the actual values, a sensitivity analysis was performed by varying the utility scores used to calculate QALYs in the model from 0.41 to 0.61. The subsequent range of QALYs was 0.017 to 0.045, respectively. If both medication and hospitalisation costs were included in the model, intravenous paricalcitol remained dominant over oral calcitriol and intravenous alfacalcidol. This means that paricalcitol and hospitalisation costs were less and utilities were greater with paricalcitol compared with oral calcitriol and intravenous alfacalcidol


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.