Abstract: FR-PO124
Estimating the Health Economic Outcomes of Serum 25-Hydroxyvitamin D and Intact Parathyroid Hormone Levels in Stage 3-4 CKD: The Impact of Treatment Timing
Session Information
- Molecular Mechanisms of CKD - II
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1903 CKD (Non-Dialysis): Mechanisms
Authors
- Gitlin, Matthew, BluePath Solutions, Los Angeles, California, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
- Hollenbeak, Christopher S., Penn State College of Medicine , Hershey, Pennsylvania, United States
- Snyder, Sophie, BluePath Solutions, Los Angeles, California, United States
- Ashfaq, Akhtar, OPKO Health, Inc., Miami, Florida, United States
Background
Serum 25-hydroxyvitamin D (25D) and intact parathyroid hormone (iPTH) levels in patients with Chronic Kidney Disease (CKD)are associated with meaningful clinical outcomes, including cardiovascular (CV) events, fractures, CKD progression, and death. This study estimated differences in outcomes (CV events, fractures, and CKD progression) and costs due to changes in 25D and iPTH levels associated with vitamin D (vit D) therapy among patients with CKD not on dialysis.
Methods
A cost-consequence model taking a Medicare payer perspective was developed to estimate the economic and clinical consequences of increasing 25D and lowering iPTH in stage 3-4 CKD patients. The base case Markov model assumed a 1000-patient cohort with 1-year cycles and a 5-year time horizon. Correction of 25D and iPTH level and associated clinical events were based on published meta-analyses. Costs of clinical events were based on data from national public databases.
Results
Across a 1,000-person cohort, increasing 25D and lowering iPTH may avert about 202 CV events, 6 fractures and 230 patient-years in the CKD stage 5/dialysis state. The estimated offsets total about $25 million (Figure 1). The analysis is sensitive to the cost inputs and the effectiveness of correcting 25D and iPTH. Under scenario analysis, when excluding the stage 5/dialysis, the total savings over a 1,000-person cohort is about $4.7 million, mainly attributable to averted CV events.
Conclusion
Vit D therapy in stage 3-4 CKD appears to be cost-saving by offsetting CV events, fractures, and CKD progression, although it may also be associated with such adverse events (AE) as hypercalcemia, hyperphosphatemia, and increased FGF23; further research is warranted to assess whether vit D treatment with extended-release calcifediol results in improved outcomes without these AEs.
Funding
- Commercial Support – OPKO