Impact of Pre-Dialysis Use of Calcitriol on Healthcare Resources Utilization and Costs Compared with No Vitamin D Receptor Activator (VDRA) Treatment for Secondary Hyperparathyroidism (SHPT)

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

Abstract:

OBJECTIVE:
To explore the impact of pre-dialysis use of calcitriol on healthcare resource utilization and costs compared with no VDRA use.

METHODS:
A retrospective matched analysis of 2,059 pre-dialysis patients per cohort was performed to compare health outcomes and costs of calcitriol use with no VDRA treatment for SHPT. Patients were matched using propensity scoring for age, gender and Charlson Co-morbidity Index, and pre-index total costs. Multivariate models were adjusted for age, gender, insurance, physician specialty, region, pre-index co-morbidities, and pre-index costs to evaluate the impact of pre-dialysis calcitriol treatment on medications, outpatient services, hospitalizations and total costs.

RESULTS:
Matched analysis showed significantly more annual medications (64 v 47.5 p<0.0001) and outpatient services (43 v 40.2, p<0.0001), higher medication costs ($9,889 v $5,746, p<0.0001), outpatient costs ($16,535 v $16,101, p<0.0001) and total costs ($42,242 v $38,507, p<0.0001) with calcitriol compared with no VDRA. Multivariate analyses demonstrated significantly greater medication use and significantly higher outpatient services, but no difference in all-cause hospitalizations with calcitriol cohort compared with no VDRA cohort. Total costs were significantly greater in calcitriol cohort compared with no VDRA.

CONCLUSION:
Calcitriol treatment of SHPT in pre-dialysis patients is associated with more medications, outpatient services, and cardiovascular-related hospitalizations, and higher total costs compared with no VDRA treatment. No difference in all-cause hospitalizations was seen between cohorts. Further research is needed to confirm these findings.