Garside R et al. (2007) The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective. Nephrol Dial Transplant 22: 1428–1436

Secondary hyperparathyroidism is common in end-stage renal disease, and the standard treatment, which involves dietary control, phosphate binders and vitamin D supplementation, is not always effective. Cinacalcet is a first-in-class calcimimetic drug that suppresses parathyroid hormone production, thereby reducing serum calcium and phosphate levels. Garside et al. developed a Markov state transition model to compare the cost-utility of cinacalcet in combination with standard care with that of standard care alone in a hypothetical cohort of 1,000 patients with hyperparathyroidism secondary to end-stage renal disease.

Compared with standard treatment alone, it was calculated that cinacalcet in combination with standard treatment would provide an additional 0.34 quality-adjusted life years, at a cost of £21,167 (approximately US$40,908) per patient. This value equates to an incremental cost-effectiveness ratio of £61,890 (approximately $119,606) per quality-adjusted life year, which exceeds the usual 'willingness to pay' threshold of the National Health Service in the UK. The model predicted few differences in the incidences of major fractures, cardiovascular events and surgical mortality between treatment regimens, but a significantly lower incidence of parathyroidectomy with cinacalcet use (P <0.001). One-way sensitivity analyses indicated that if the price of cinacalcet was nearly halved, it would be considered cost-effective in the UK.