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.

5. Conclusion

This analysis suggests a clear benefit of intravenous paricalcitol with respect to costs, effectiveness and utilities compared with oral calcitriol and intravenous alfacalcidol in the treatment of patients with secondary hyperparathyroidism from the perspective of a third-party payer. Since direct comparative studies are not available, some assumptions were made in this analysis, which was based on results of historical cohort studies. Therefore, further investigation is required to verify the appropriateness of these assumptions.

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Funding information

Compilation of this review was funded by Abbott prior to completion of the review, and funding was thus independent of the research results.

Reprint Address

Correspondence and offprints: Dr Hubertus Rosery, Analytica International GmbH, German Office, Untere Herrenstrasse 25, POB 1770, D-79539 Loerrach, Germany. E-mail: hrosery@de.analyticaintl.com

The use of trade names is for product identification purposes only and does not imply endorsement.

Cite this: Health-Economic Comparison of Paricalcitol, Calcitriol and Alfacalcidol for the Treatment of Secondary Hyperparathyroidism during Haemodialysis - Medscape - Nov 01, 2006.

Table I. Medication Costs for Alfacalcidol, Calcitriol and Paricalcitol ^a
Medication	Package size	Cost/pack ()	Cost/dialysis^b ()	Cost/day ()	Cost/year ()
Alfacalcidol
Eins Alpha^® capsule	100 × 0.5μg	103.36	2.41	1.03	375.95
Eins Alpha^® injection	10 × 1.0mL(2 μg/mL)	158.46	15.84	6.79	2478.35
Calcitriol
Bocatriol^® capsule	100 × 0.5μg	104.01	2.43	1.04	379.60
Calcitriol-Nephro^® capsule	100 × 0.5μg	100.82	2.35	1.00	365.00
Decostriol^® capsule	100 × 0.5μg	104.01	2.43	1.04	379.60
Rocaltrol^® capsule	100 × 0.5μg	128.67	3.00	1.29	470.85
Intravenous paricalcitol
Zemplar^®	5 × 5μg	127.18	25.44	10.90	3978.50

^aSource: German Red List, January 2005.
^bAssumes three dialysis sessions per week.

Table II. Diagnosis-related Groups (DRGs) for Kidney Disease With Dialysis in Germany ^a
DRG	Description	Points	Base-case value ()	Costs per admissioncase ()
L60A	Kidney disease with dialysis haemolytic-uraemic syndrome or complex diagnosis and extremely severe complications	3.117	2800	8727.60
L60B	Kidney disease with dialysis not haemolytic-uraemic syndrome but complex diagnosis and extremely severe complications	2.277	2800	6375.60
L60C	Kidney disease with dialysis not haemolytic-uraemic syndrome or complex diagnosis or extremely severe complicationsorKidney disease without dialysis with haemolytic-uraemic syndrome or extremely severe complications	1.532	2800	4289.60

^aReference year for DRG values = 2005.

Table III. Published Utility Scores for End-stage Renal Disease and Haemodialysis
Health state	Score	Reference	Year of publication
End-stage renal disease	0.59	Lawrence et al.^[32]	1995
End-stage renal disease	0.61	Eastman et al.^[33]	1997
End-stage renal failure	0.567	Kiberd and Jindal^[34]	1995
End-stage renal failure due to diabetes	0.61	Diabetes Group^[35]	1996
End-stage renal failure	0.61	van Os et al.^[36]	2000
End-stage renal failure	0.576	Kiberd and Jindal^[37]	1998
Patients with end-stage renal disease treated with
full-care centre haemodialysis	0.66	de Wit et al.^[38]	1998
limited-care centre haemodialysis	0.81	de Wit et al.^[38]	1998
Dialysis	0.41	Kiberd^[39]	1994
Dialysis	0.43	Churchill et al.^[40]	1987
Dialysis	0.453	Coffey et al.^[41]	2002

Table I. Medication Costs for Alfacalcidol, Calcitriol and Paricalcitol ^a
Medication	Package size	Cost/pack ()	Cost/dialysis^b ()	Cost/day ()	Cost/year ()
Alfacalcidol
Eins Alpha^® capsule	100 × 0.5μg	103.36	2.41	1.03	375.95
Eins Alpha^® injection	10 × 1.0mL(2 μg/mL)	158.46	15.84	6.79	2478.35
Calcitriol
Bocatriol^® capsule	100 × 0.5μg	104.01	2.43	1.04	379.60
Calcitriol-Nephro^® capsule	100 × 0.5μg	100.82	2.35	1.00	365.00
Decostriol^® capsule	100 × 0.5μg	104.01	2.43	1.04	379.60
Rocaltrol^® capsule	100 × 0.5μg	128.67	3.00	1.29	470.85
Intravenous paricalcitol
Zemplar^®	5 × 5μg	127.18	25.44	10.90	3978.50

^aSource: German Red List, January 2005.
^bAssumes three dialysis sessions per week.

Table II. Diagnosis-related Groups (DRGs) for Kidney Disease With Dialysis in Germany ^a
DRG	Description	Points	Base-case value ()	Costs per admissioncase ()
L60A	Kidney disease with dialysis haemolytic-uraemic syndrome or complex diagnosis and extremely severe complications	3.117	2800	8727.60
L60B	Kidney disease with dialysis not haemolytic-uraemic syndrome but complex diagnosis and extremely severe complications	2.277	2800	6375.60
L60C	Kidney disease with dialysis not haemolytic-uraemic syndrome or complex diagnosis or extremely severe complicationsorKidney disease without dialysis with haemolytic-uraemic syndrome or extremely severe complications	1.532	2800	4289.60

^aReference year for DRG values = 2005.

Table IV. Sensitivity Analysis of Incremental Costs of Intravenous (IV) Paricalcitol Compared With Oral Calcitriol and IV Alfacalcidol Based on German Diagnosis-related Groups (DRG L60A ^a and L60C ^a)
Variable	Oral calcitriol	IV alfacalcidol
Medication costs ()	-3604	-1501
Hospitalisation costs L60A ()	+7384	+7384
Total incremental costs ()	+3780	+5883
Hospitalisation costs L60C ()	+3629	+3629
Total incremental costs ()	+25	+2128

^aSee Table II .

Table V. Incremental Costs, Incremental Survival Rates and Incremental Utilities of Intravenous (IV) Paricalcitol Compared With Oral Calcitriol and IV Alfacalcidol
Variable	IV paricalcitol	Oral calcitriol	IV alfacalcidol
Medication costs ()		-3604	-1501
Hospitalisation costs L60B^a ()		+5394	+5394
Incremental total costs ()		+1790	+3893
Incremental 1-year survival rate	0.04
Incremental utilities	0.030

^aSee Table II .

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

5. Conclusion

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