nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2018-4-378-384nid-351Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЭффективность затрат на парикальцитол у пациентов на гемодиализе с вторичным гиперпаратиреозомCost-effectiveness of paricalcitol in hemodialysis patients with secondary hyperparathyroidismРудаковаА. В.RudakovaA. V.rudakova_a@mail.ruСанкт-Петербургский государственный химико-фармацевтический университетРоссияSaint Petersburg State Chemical Pharmaceutical UniversityRussian Federation201812082024204378384Copyright © Рудакова А.В., 20242024Рудакова А.В.Rudakova A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/351

Целью исследования являлась оценка эффективности затрат на внутривенно вводимый парикальцитол по сравнению с неселективными активаторами рецепторов витамина D (ВДРА) у пациентов на гемодиализе с хронической болезнью почек (ХБП) и вторичным гиперпаратиреозом без гиперкальциемии и гиперфосфатемии в РФ. Пациенты и методы: проведен анализ данных пациентов на гемодиализе с уровнем паратиреоидного гормона, превышающим 300 пг/мл, несмотря на стандартную терапию, включавшую ограничение потребления фосфора и прием фосфат-связывающих препаратов, без гиперкальциемии и гиперфосфатемии. Использовано марковское моделирование на основе данных клинических исследований и эпидемиологических данных по РФ с учетом тарифов ОМС по Санкт-Петербургу. Оценка проводилась с позиции системы здравоохранения с использованием 15-летнего временного горизонта. Затраты и продолжительность жизни дисконтировали на 3,5% в год. Результат: в соответствии с результатами моделирования, терапия парикальцитолом может обеспечить увеличение средней продолжительности жизни по сравнению с неселективными ВДРА на 0,683 года (без дисконтирования). Эффективность дополнительных затрат на парикальцитол, с учетом сделанных допущений, составит 1820,7 тыс. руб./QALY и 1234,0 тыс. руб./дополнительный год жизни. На результаты оценки эффективности затрат существенное влияние оказывает тяжесть вторичного гиперпаратиреоза, влияющая на дозу парикальцитола, назначаемую пациентам. Выводы: терапия парикальцитолом пациентов на гемодиализе с ХБП и вторичным гиперпаратиреозом без гиперкальциемии и гиперфосфатемии может рассматриваться, с учетом сделанных допущений, в качестве экономически приемлемого для российской системы здравоохранения нововведения.

The objective of this study was to determine the cost effectiveness of intravenous paricalcitol versus non-selective vitamin D receptor agonists (VDRA) in patients with chronic kidney disease (CKD) and a secondary hyperparathyroidism, although without hypercalcemia and hyperphosphatemia in Russian Federation. Patients and methods: the analysis was carried out for hemodialysis patients with the level of serum parathyroid hormone over 300 pg/ml despite the standard therapy including restriction of phosphorus consumption and phosphate-binding agents, without hypercalcemia and hyperphosphatemia. Markov modeling on the basis of clinical trials and epidemiological data on the Russian Federation taking into account tariffs of compulsory health insurances across St. Petersburg is used. Assessment was carried out from a health care payer perspective with use of the 15-year temporary horizon. Clinical and economic outcomes were discounted at 3.5% a year. Results: according to results of modeling, paricalcitol can provide the increase in average life expectancy in comparison with non-selective VDRA for 0.683 year (without discounting). The cost effectiveness of paricalcitol, taking into account the made assumptions, will be 1820.7 thousand rubles/QALY and 1234.0 thousand rubles /LYG. The dose of a paricalcitol at therapy of this group of patients has significant effect on results of cost-effectiveness assessment. Conclusions: paricalcitol in hemodialysis patients with CKD and a secondary hyperparathyroidism without hypercalcemia and hyperphosphatemia can be considered, taking into account assumptions made during modeling, as economically acceptable for the health care system in Russia.

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The authors declare that there are no conflicts of interest present.