Cinacalcet - Clinical and Laboratory Effectiveness, Concomitant Treatment Patterns and Treatment Cost: Could We Do Better and How?

Background: The cost and effectiveness patterns in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients in the Czech Republic are unknown. Methods: 52 dialysis patients from 17 centers were followed up in a multicenter prospective study of laboratory and clinical (hospitalization rate, clinical complaints questionnaire) responses to 12-month cinacalcet treatment. Treatment patterns and cost (including phosphate binders, vitamin D, and cinacalcet) were evaluated. Results: The mean s-Ca dropped significantly from 2.36 +/- 0.24 to 2.21 +/- 0.20 mmol/l, s-P from 2.45 +/- 0.54 to 2.01 +/- 0.53 mmol/l, Ca x P from 5.79 +/- 1.25 to 4.42 +/- 1.13 mmol(2)/l(2), and iPTH dropped from 919.0 +/- 465.6 to 372.1 +/- 294.6 pg/ml. The mean cinacalcet dose reached 44.1 +/- 23.0 mg/day after 12 months. Itching intensity decreased significantly. No change in hospitalization rate was observed. The direct cost of daily SHPT treatment rose significantly from EUR 8.77 +/- 9.59 to 20.62 +/- 9.22. Conclusions: Cinacalcet decreased elevated s-Ca, s-P, Ca x P, and iPTH, alleviated itching, and significantly raised the SHPT treatment cost. A minority of patients reached K/DOQI targets, especially due to poor phosphate control caused by insufficient phosphate binder treatment, cinacalcet underdosing, and advanced SHPT. Copyright (C) 2010 S. Karger AG, Basel