An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism—the German perspective

Schneider, Ralph; Kolios, Georgios; Koch, Benjamin M.; Fernández, Emilio Domínguez; Bartsch, Detlef K.; Schlosser, Katja

doi:10.1016/j.surg.2010.09.009

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Volume 148, Issue 6 , Pages 1091-1099, December 2010

An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism—the German perspective

Ralph Schneider, MD
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
- Reprint requests: Ralph Schneider, MD, Philipps University Marburg, Department of Visceral, Thoracic and Vascular Surgery, Baldingerstrasse, 35043 Marburg, Germany.
Georgios Kolios, MD
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Bremen, Germany
Benjamin M. Koch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
Emilio Domínguez Fernández, MD
- Department of General, Visceral and Vascular Surgery, Clinical Centre Nordstadt, Hannover, Germany
Detlef K. Bartsch, MD
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany
Katja Schlosser, MD
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany

Accepted 18 December 2010.

Background

Treatment options for secondary hyperparathyroidism were significantly amended with the introduction of cinacalcet and paricalcitol. Limitations of resources in public health systems demand detailed analyses of accruing costs. The aim of this study was to compare the costs of these new treatment modalities to surgery.

Methods

Patients who underwent initial parathyroidectomy (n = 91) and patients treated with cinacalcet or paricalcitol (n = 100) at an ambulatory dialysis center between 01/2003 and 12/2006 were analyzed. The revenues of both therapies for the funding agencies were calculated by a cost-cost analysis. The real arising costs of the supplier were analyzed and compared to the revenues.

Results

Treatment costs for cinacalcet (60 mg/day/year) were 5828.40€ and 4485.20€ for paricalcitol (15 μg/week/year). Revenues for inpatient surgical treatment according to the German DRG system were 3755.38€/case. Additionally, costs for postoperative ambulatory therapies were 545.05€ for the first year and 384.97€ for the following.

Conclusion

Due to linearly increases, expenses of medical treatment with cinacalcet for more than 9 months or paricalcitol for more than 12 months exceeded the costs of surgical therapy. The indication of these new medical therapies should be restricted to patients as an interim solution ahead of surgery or in patients considered unfit for surgery.