Is Cinacalcet Cost-Effective? 

Komaba et al, pages 262-271; and Yuan et al, pages 179-181.

American Journal of Kidney Diseases Volume 60, Issue 2 , Pages A23-A24, August 2012

Secondary hyperparathyroidism (SHPT) is ubiquitous in patients with chronic kidney failure treated by long-term dialysis; cinacalcet effectively reduces elevated levels of parathyroid hormone in these patients. In this issue of AJKD, Komaba and colleagues report a pharmacoeconomic analysis of cinacalcet plus conventional therapy compared with conventional therapy alone in a theoretical cohort of Japanese hemodialysis patients. Strikingly, the investigators found that while cinacalcet was cost-effective in less than 1% of simulations in patients who were eligible for parathyroidectomy, cinacalcet was cost-effective in more than 99% of simulations in those who were not surgery candidates. Yuan et al comment on this striking dichotomy and call for nephrologists to consider establishing the optimal use of cinacalcet as an opportunity to set priorities in order to reduce expenditures in the face of global reimbursement reduction.