PubMed · 15452465
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2004-09-27. Cinacalcet (sensipar).. https://pubmed.ncbi.nlm.nih.gov/15452465/
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Calcimimetics drug such as cinacalcet suppress the secretion of parathyroid hormone by sensitizing parathyroid calcium receptors to extracellular ionized calcium. Standard treatment for secondary hyperparathyroidism is associated with the risk of hypercalcemia, but cinacalcet don't induce elevation of serum calcium. And some studies were reported the use of cinacalcet not only to manage primary hyperparathyroidism, but also secondary hyperparathyroidism in nondialyzed stage, renal transplant patients and parathyroid carcinoma.
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BACKGROUND: Controversy exists concerning the best treatment for asymptomatic primary hyperparathyroidism (PHPT) when the National Institutes of Health consensus conference criteria for parathyroidectomy are not met. We hypothesized that parathyroidectomy would be more cost-effective than observation or pharmacologic therapy for these patients. METHODS: Cost-effectiveness analysis was performed comparing treatment strategies for asymptomatic PHPT. Treatment outcomes, their probabilities, and costs were identified on the basis of literature and cost database review. Outcomes were weighted by using established quality-of-life utility factors. Sensitivity analysis was used to examine the uncertainty of costs and utility estimates in the model. RESULTS: The incremental cost-effectiveness ratio for parathyroidectomy was US dollars 4778 per quality-adjusted life year (QALY) gained. Operation remained cost-effective until the average cost of parathyroidectomy increased from the estimated value of US dollars 4778 to US dollars 14,650. Pharmacologic therapy was not cost-effective unless the annual cost of therapy decreased from an estimated US dollars 7406 (for cinacalcet) to US dollars 221. Parathyroidectomy ceases to be preferred over monitoring if a quality-of-life difference is not demonstrable after curative operation. CONCLUSIONS: Parathyroidectomy is more cost-effective than observation for managing asymptomatic PHPT patients who do not meet National Institutes of Health criteria for parathyroidectomy. Furthermore, pharmacologic therapies with a greater than US dollars 221 annual cost were not cost-effective in this model.