All-Cause and Cardiovascular-Related Healthcare Resource Utilization and Costs Associated with Paricalcitol Use in Pre-Dialysis Chronic Kidney Disease (CKD) Patients with Secondary Hyperparathyroidism (SHPT) Compared with No Vitamin D Receptor Activator (VDRA) Therapy

Authors:
Steven E. Marx,¹
Carla Frye,²
Dennis L. Andress,¹
Qing Harshaw,²
Raimund Sterz,¹
Katie Deering,²
Paul Audhya.¹

Abstract:

OBJECTIVE:
To assess healthcare resource utilization and costs in pre-dialysis CKD patients with SHPT receiving paricalcitol compared to no VDRA treatment.

METHODS:
MedStat™ database containing 29,151 patients with CKD and SHPT was analyzed to compare matched cohorts of patients treated with paricalcitol vs. no VDRA treatment. 279 patients per cohort were matched using propensity scoring of age, gender, Charlson Co-morbidity Index, and pre-index total cost. Multivariate analyses adjusting for baseline age, gender, CKD severity, insurance, physician specialty, region, pre-index co-morbidities, and pre-index costs were used to explore differences.

RESULTS:
Matched analysis showed significantly fewer annual hospital days (1.7 vs 5, p<0.0001), hospitalizations (0.4 vs 0.7, p<0.0001) and hospitalization costs ($5,635 vs $13,650, p<0.0001) per patient with paricalcitol compared to no VDRA despite the higher number of medications (58.5 vs 43.2, p<0.0001) and medication costs ($8,385 vs $4,692, p<0.0001) in the paricalcitol cohort. Multivariate analyses demonstrated similar results with 32% fewer all-cause hospitalizations and 12.6% lower all-cause total costs:

CONCLUSION:
This is the first study to show the impact of pre-dialysis use of paricalcitol on cardiovascular-related and all-cause health outcomes and costs compared with no VDRA treatment. Although medication use was higher in those receiving paricalcitol, this was offset by significantly fewer outpatient visits and hospitalizations, as well as lower total costs compared with no VDRA. Randomized controlled studies may be needed to confirm these findings.