Cinacalcet adherence in dialysis patients with secondary hyperparathyroidism in Lombardy Region: clinical implications and costs

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Background: Patients on dialysis often have secondary hyperparathyroidism (SHPT), a disorder associated with renal osteodystrophy, progressive vascular calcification, cardiovascular disease, and death. The objective of this retrospective observational study was to evaluate, in dialysis patients with SHPT, the impact of different levels of adherence to cinacalcet therapy on hospitalisations and direct healthcare costs charged to the Lombardy Regional Health Service (Italy).

Methods: Data recorded in the administrative databases on all citizens undergoing dialysis between 1 January 2011 and 31 December 2011 were selected. For the aim of this study, patients with SHPT already on dialysis in the first 6 months of 2009 who had been treated with cinacalcet for at least 365 days were selected and retrospectively analysed through to end of 2012. Healthcare resource utilisation, cinacalcet adherence, and costs for medication, hospitalisations, and diagnostic/therapeutic procedures were estimated.

Results: A total of 994 patients were identified (mean age 63.0 years, females 43.5%). The first patient tertile had an adherence to cinacalcet of <64.1%, whereas the third had an adherence of over 91.5%. Patients in the third adherence tertile experienced fewer all-causes hospitalisations than those in the first tertile (−19.2%; p=0.01423), fractures (−37.1%; p=0.59422), cardiovascular disease (−23.8%; p=0.04025), and sepsis (−32.3%; p=0.01386). The increase in costs for cinacalcet-adherent patients is almost completely offset by the reduction in costs for hospitalisations.

Conclusions: The results of the analysis suggest that there may be some correlation between a high level of cinacalcet adherence and a decrease in hospitalisations.

Keywords: cinacalcet, costs, dialysis, SHPT, therapeutic adherence.

Citation: Roggeri A, Conte F, Rossi C, Cozzolino M, Zocchetti C, Roggeri DP. Cinacalcet adherence in dialysis patients with secondary hyperparathyroidism in Lombardy Region: clinical implications and costs. Drugs in Context 2020; 9: 2020-1-1. DOI: 10.7573/dic.2020-1-1

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Alessandro Roggeri and Daniela Paola Roggeri report consultancy fees from AstraZeneca and Amgen, outside the submitted work. Mario Cozzolino reports personal fees from Vifor Pharma, personal fees from Amgen, grants and personal fees from Shire, and grants and personal fees from Baxter, outside the submitted work. All other authors declare that they have no conflict of interest.

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article. No funding was received for this study.

Copyright: Copyright © 2020 Roggeri A, Conte F, Rossi C, Cozzolino M, Zocchetti C, Roggeri DP. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

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Correspondence: Alessandro Roggeri, Via Camozzi 1/C 24027, Nembro, BG, Italy.

Provenance: submitted; externally peer reviewed.

Submitted: 1 January 2020; Peer review comments to author: 10 February 2020; Revised manuscript received: 1 March 2020; Accepted: 6 March 2020; Publication date: 27 March 2020.

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