Abstract: FR-PO0254
Etelcalcetide Use Rates Decrease and Parathyroidectomy Rates Increase Following the Incorporation of Calcimimetics into the ESKD Bundle
Session Information
- Bone and Mineral Metabolism: Clinical Epidemiology and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Martin, Kevin J., Division of Nephrology, Saint Louis University School of Medicine, St. Louis, Missouri, United States
- Sprague, Stuart Michael, Division of Nephrology and Hypertension NorthShore University Health System, Evanston, Illinois University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
Background
Secondary hyperparathyroidism (SHPT) is a complication of end-stage kidney disease (ESKD) and is more prevalent in Black patients (pts). Severe cases may require parathyroidectomy (PTX). Calcimimetics, such as cinacalcet and etelcalcetide (ETEL), are used to manage SHPT and reduce the risk of PTX. The Transitional Drug Add-On Payment Adjustment (TDAPA) policy established support for the adoption of new treatments, like ETEL, for ESKD. TDAPA payments for ETEL were provided from 2018-2021, after which ETEL was incorporated into the ESKD bundle that includes a single, standardized payment for all hemodialysis (HD) patients, regardless of the need for calcimimetic therapy. This study examines trends in calcimimetic use and PTX rates among HD pts during and after TDAPA, considering race and dialysis organization (DO) size.
Methods
Calcimimetic use and PTX events were identified for pts on HD enrolled in fee-for-service Medicare in 2016-2021, with data supplied by the United States Renal Data System.
Results
ETEL use increased during the TDAPA period and decreased sharply when it ended (Figure), with many pts switching back to cinacalcet. Conversely, PTX rates declined during the TDAPA period to 3.4 per 1000 pt-years and increased to 4.4 per 1000 pt-years upon its conclusion. These trends in ETEL use and PTX rates were most pronounced for small/medium DOs (S/MDOs) and Black pts. After TDAPA, PTX rates rose from 2.9 to 4.8 and 4.6 to 6.5 per 1,000 pt-years in S/MDOs and Black pts, respectively.
Conclusion
These findings highlight the impact of reimbursement policy on clinical practice and pt outcomes, underlining the unintended consequences of reducing access to effective therapies, increasing health disparities, and potentially suppressing future therapeutic innovation.
Funding
- Commercial Support – Ardelyx, Inc.