Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: A cost-effectiveness analysis. Surgery 2021 Jan;169(1):94-101
Date
08/01/2020Pubmed ID
32732069DOI
10.1016/j.surg.2020.06.012Scopus ID
2-s2.0-85088809164 (requires institutional sign-in at Scopus site) 17 CitationsAbstract
BACKGROUND: Tertiary hyperparathyroidism associated with end-stage renal disease is characterized by progression from secondary hyperparathyroidism to an autonomous overproduction of parathyroid hormone that leads to adverse health outcomes. Rates of parathyroidectomy (PTX) have decreased with the use of calcimimetics. Optimal timing of PTX in relation to kidney transplant remains controversial. We aimed to identify the most cost-effective strategy for patients with tertiary hyperparathyroidism undergoing kidney transplant.
METHODS: We constructed a patient level state transition microsimulation to compare 3 management schemes: cinacalcet with kidney transplant, cinacalcet with PTX before kidney transplant, or cinacalcet with PTX after kidney transplant. Our base case was a 55-year-old on dialysis with tertiary hyperparathyroidism awaiting kidney transplant. Outcomes, including quality-adjusted life years, surgical complications, and mortality, were extracted from the literature, and costs were estimated using Medicare reimbursement data.
RESULTS: Our base case analysis demonstrated that cinacalcet with PTX before kidney transplant was dominant, with a lesser cost of $399,287 and greater quality-adjusted life years of 10.3 vs $497,813 for cinacalcet with PTX after kidney transplant (quality-adjusted life years 9.4) and $643,929 for cinacalcet with kidney transplant (quality-adjusted life years 7.4).
CONCLUSION: Cinacalcet alone with kidney transplant is the least cost-effective strategy. Patients with end-stage renal disease-related tertiary hyperparathyroidism should be referred for PTX, and it is most cost-effective if performed prior to kidney transplant.
Author List
McManus C, Oh A, Lee JA, Hur C, Kuo JHAuthor
Catherine McManus MD, MS Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Calcimimetic AgentsCalcium
Computer Simulation
Cost-Benefit Analysis
Disease Progression
Humans
Hyperparathyroidism, Secondary
Hyperplasia
Kidney Failure, Chronic
Medicare
Middle Aged
Parathyroid Glands
Parathyroid Hormone
Parathyroidectomy
Quality-Adjusted Life Years
Renal Dialysis
Renal Elimination
Time-to-Treatment
United States
