Introduction: Persistent or intractable PHPT can lead to neuromuscular and psychiatric symptoms and may increase the long-term risk for cardiovascular disease and fractures. Cinacalcet (Mimpara/Sensipar) represents an innovative treatment option for this small group of patients, as it directly acts on the calcium sensing receptors on cell surfaces, reducing the severity of hypercalcemia.
Purpose: To estimate the UK budget impact of cinacalcet in patients with intractable PHPT.
Methods: A 5-year budget impact model was developed in Microsoft Excel. Total treatment costs were estimated for two types of patient populations with intractable PHPT: failed PTX surgery and contraindicated for PTX surgery. Total treatment costs incurred in the first year were used for incident cases, costs in subsequent years (average of 9 years) were used for prevalent cases. Cost-offsets were modelled for short- and long-term consequences: Short-term (ST) costs included re-operation, pharmaceuticals, physician visits and lab tests/procedures. Long-term (LT) costs included the cost of treating hypertension, fractures, anxiety, and CVD events. The ability of cinacalcet to induce cost offsets was based on the efficacy of cinacalcet as estimated in clinical trials.
Results: Using epidemiological information, there are ~755 intractable PHPT patients in the UK. The budget impact models shows, assuming a 3 to 15% market share in years 1 to 5 in both populations, increased total costs associated with the launch of cinacalcet from 7% in year 1 to 34% in year 5 compared to not using cinacalcet or £119 000 additional costs in year 1 to £602 000 in year 5.
Conclusion: The overall budget impact of cinacalcet is limited due to the restricted population affected with this serious form of PHPT, the conservative market share estimates and the cost-offsets from LT events.
25 - 29 Apr 2009
European Society of Endocrinology