Cost-effectiveness analysis comparison of etelcalcetide, paricalcitol, and cinacalcet for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease

BACKGROUND: Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease (CKD), which can lead to cardiovascular diseases and the risk of fractures. Calcimimetics and active vitamin D analogs are the most frequently prescribed therapeutic drugs for treating this illness. RESEARCH DESIGN AND METHODS: A decision-tree model was constructed from the perspective of the Chinese healthcare system, with a 1-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed. RESULTS: Total annual costs were 20,771 yuan for cinacalcet, 34,350 yuan for paricalcitol, and 52,388 yuan for etelcalcetide. The ICER of etelcalcetide versus cinacalcet was 191,156.12 yuan per additional effective case, and 113,020.05 yuan versus paricalcitol. Cost-effectiveness acceptability curves indicated that cinacalcet was the optimal strategy when willingness-to-pay (WTP) was below 95,000 yuan per additional effective case; etelcalcetide became more cost-effective than paricalcitol when WTP exceeded 110,000 yuan per additional effective case, and became the optimal strategy among the three when WTP exceeded 190,000 yuan per additional effective case. CONCLUSION: The optimal pharmacological strategy for SHPT depends on the WTP threshold. Cinacalcet is preferred at lower WTP levels, while etelcalcetide offers superior cost-effectiveness at higher WTP.