Vasily Belozeroff1, Glenn M Chertow2, Christopher N Graham3, Bastian Dehmel4, Patrick S Parfrey5, Andrew H Briggs6. 1. Amgen Inc., Thousand Oaks, CA, USA. Electronic address: vasilyb@amgen.com. 2. Stanford University School of Medicine, Palo Alto, CA, USA. 3. RTI Health Solutions, Research Triangle Park, NC, USA. 4. Amgen Inc., Thousand Oaks, CA, USA. 5. Memorial University, St. John's, Newfoundland, Canada. 6. Health Economics & Health Technology Assessment, University of Glasgow, Glasgow, UK.
Abstract
BACKGROUND: Previous economic evaluations of cinacalcet in patients with secondary hyperparathyroidism (sHPT) relied on the combination of surrogate end points in clinical trials and epidemiologic studies. OBJECTIVES: The objective was to conduct an economic evaluation of cinacalcet on the basis of the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial from a US payer perspective. METHODS: We developed a semi-Markov model to assess the cost-effectiveness of cinacalcet in addition to conventional therapy, compared with conventional therapy alone, in patients with moderate-to-severe sHPT receiving hemodialysis. We used treatment effect estimates from the unadjusted intent-to-treat (ITT) analysis and prespecified covariate-adjusted ITT analysis as our main analyses. We assessed model sensitivity to variations in individual inputs and overall decision uncertainty through probabilistic sensitivity analyses. RESULTS: The incremental cost-effectiveness ratio (ICER) for cinacalcet was $61,705 per life-year and $79,562 per quality-adjusted life-year (QALY) gained using the covariate-adjusted ITT analysis. Probabilistic sensitivity analysis suggested a 73.2% chance of the ICER being below a willingness-to-pay threshold of $100,000. Treatment effects from unadjusted ITT analysis yielded an ICER of $115,876 per QALY. The model was most sensitive to the treatment effect on mortality. CONCLUSIONS: In the unadjusted ITT analysis, cinacalcet does not represent a cost- effective use of health care resources when applying a willingness-to-pay threshold of $100,000 per QALY. When using the covariate-adjusted ITT treatment effect, which represents the least biased estimate, however, cinacalcet is a cost-effective therapy for patients with moderate-to-severe sHPT on hemodialysis.
RCT Entities:
BACKGROUND: Previous economic evaluations of cinacalcet in patients with secondary hyperparathyroidism (sHPT) relied on the combination of surrogate end points in clinical trials and epidemiologic studies. OBJECTIVES: The objective was to conduct an economic evaluation of cinacalcet on the basis of the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial from a US payer perspective. METHODS: We developed a semi-Markov model to assess the cost-effectiveness of cinacalcet in addition to conventional therapy, compared with conventional therapy alone, in patients with moderate-to-severe sHPT receiving hemodialysis. We used treatment effect estimates from the unadjusted intent-to-treat (ITT) analysis and prespecified covariate-adjusted ITT analysis as our main analyses. We assessed model sensitivity to variations in individual inputs and overall decision uncertainty through probabilistic sensitivity analyses. RESULTS: The incremental cost-effectiveness ratio (ICER) for cinacalcet was $61,705 per life-year and $79,562 per quality-adjusted life-year (QALY) gained using the covariate-adjusted ITT analysis. Probabilistic sensitivity analysis suggested a 73.2% chance of the ICER being below a willingness-to-pay threshold of $100,000. Treatment effects from unadjusted ITT analysis yielded an ICER of $115,876 per QALY. The model was most sensitive to the treatment effect on mortality. CONCLUSIONS: In the unadjusted ITT analysis, cinacalcet does not represent a cost- effective use of health care resources when applying a willingness-to-pay threshold of $100,000 per QALY. When using the covariate-adjusted ITT treatment effect, which represents the least biased estimate, however, cinacalcet is a cost-effective therapy for patients with moderate-to-severe sHPT on hemodialysis.
Authors: Antonio Bellasi; Luigi Morrone; Maria Cristina Mereu; Carlo Massimetti; Elena Pelizzaro; Giuseppe Cianciolo; Marzia Pasquali; Vincenzo Panuccio Journal: J Nephrol Date: 2018-03-07 Impact factor: 3.902
Authors: Björn Stollenwerk; Sergio Iannazzo; Ron Akehurst; Michael Adena; Andrew Briggs; Bastian Dehmel; Patrick Parfrey; Vasily Belozeroff Journal: Pharmacoeconomics Date: 2018-05 Impact factor: 4.981
Authors: Patrick S Parfrey; Geoffrey A Block; Ricardo Correa-Rotter; Tilman B Drüeke; Jürgen Floege; Charles A Herzog; Gerard M London; Kenneth W Mahaffey; Sharon M Moe; David C Wheeler; Glenn M Chertow Journal: Clin J Am Soc Nephrol Date: 2015-11-27 Impact factor: 8.237
Authors: R R Dulfer; E Y Koh; W Y van der Plas; A F Engelsman; E J M Nieveen van Dijkum; R A Pol; L Vogt; M H de Borst; S Kruijff; A Schepers; N M Appelman-Dijkstra; J I Rotmans; D A Hesselink; C H J van Eijck; E J Hoorn; T M van Ginhoven Journal: Langenbecks Arch Surg Date: 2019-02-07 Impact factor: 3.445