Objective

To analyze the economic burden of secondary hyperparathyroidism (sHPT) in Spain by quantifying differences in costs of pharmacological treatments and associated cardiovascular events (CVE) between renal patients with and without sHPT.

Methods

We used data collected in the NEFRONA cohort study and obtained treatment and CVE costs from the BOT PLUS database and Hospital Discharge Records in the Spanish Health System (CMBD-H), respectively. We examined data from 2445 renal patients followed during 2 years for chronic kidney disease (CKD) progression and 4 years for CVE, stratifying by presence of sHPT. Patient characteristics, administered treatments and CVE were directly extracted from NEFRONA registries. Dosage for each treatment regimen was assumed based on guidelines and multiplied by official unit costs to obtain treatment costs. Costs of CVE were based on ICD-9-CM.

Results

Prevalence of sHPT in the cohort was 65.6% (63.6; 67.6). Average yearly pharmacological costs for patients without sHPT were 610.33€, while costs were 1483.17€ for sHPT patients (average increase of 143.0%). Two hundred three patients registered CVE, resulting in 4-year average costs of 582.57€ for non-sHPT patients compared to 941.87€ for sHPT patients (61.7% average increase). Bivariate analyses considering presence of dialysis, hypercalcemia or hyperphosphatemia and stratified by sHPT showed higher costs for sHPT patients.

Conclusions

These results show that sHPT is associated with substantially higher costs of both, pharmacological treatments and associated CVEs. Preventing the development of sHPT with early management in the course of CKD could possibly lead to better health outcomes and cost balance for health care systems.

中文翻译：

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西班牙有和没有继发性甲状旁腺功能亢进症患者的医疗保健费用

客观的

通过量化有和没有 sHPT 的肾脏患者的药物治疗成本和相关心血管事件 (CVE) 的差异，分析西班牙继发性甲状旁腺功能亢进症 (sHPT) 的经济负担。

方法

我们使用了 NEFRONA 队列研究中收集的数据，并分别从 BOT PLUS 数据库和西班牙卫生系统 (CMBD-H) 的医院出院记录中获得了治疗和 CVE 成本。我们检查了 2445 名肾病患者的数据，这些患者在 2 年的慢性肾脏病 (CKD) 进展和 4 年的 CVE 期间随访，根据 sHPT 的存在进行分层。患者特征、实施的治疗和 CVE 直接从 NEFRONA 登记处提取。每种治疗方案的剂量是根据指南假设的，并乘以官方单位成本以获得治疗成本。CVE 的成本基于 ICD-9-CM。

结果

该队列中 sHPT 的患病率为 65.6% (63.6; 67.6)。没有 sHPT 的患者的年平均药理费用为 610.33 欧元，而 sHPT 患者的费用为 1483.17 欧元（平均增长 143.0%）。203 名患者注册了 CVE，导致非 sHPT 患者的 4 年平均费用为 582.57 欧元，而 sHPT 患者为 941.87 欧元（平均增加 61.7%）。考虑到透析、高钙血症或高磷血症并通过 sHPT 分层的双变量分析显示 sHPT 患者的成本更高。

结论

这些结果表明 sHPT 与药物治疗和相关 CVE 的成本显着增加有关。在 CKD 过程中通过早期管理来预防 sHPT 的发展可能会导致更好的健康结果和医疗保健系统的成本平衡。