Economic evaluation of cinacalcet in the United States: the EVOLVE trial

Belozeroff, V., Chertow, G. M., Graham, C. N., Dehmel, B., Parfrey, P. S. and Briggs, A. H. (2015) Economic evaluation of cinacalcet in the United States: the EVOLVE trial. Value in Health, 18(8), pp. 1079-1087. (doi: 10.1016/j.jval.2015.08.007) (PMID:26686794)

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Background: Previous economic evaluations of cinacalcet in patients with secondary hyperparathyroidism (sHPT) relied on the combination of surrogate end points in clinical trials and epidemiologic studies. Objectives: The objective was to conduct an economic evaluation of cinacalcet on the basis of the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial from a US payer perspective. Methods: We developed a semi-Markov model to assess the cost-effectiveness of cinacalcet in addition to conventional therapy, compared with conventional therapy alone, in patients with moderate-to-severe sHPT receiving hemodialysis. We used treatment effect estimates from the unadjusted intent-to-treat (ITT) analysis and prespecified covariate-adjusted ITT analysis as our main analyses. We assessed model sensitivity to variations in individual inputs and overall decision uncertainty through probabilistic sensitivity analyses. Results: The incremental cost-effectiveness ratio (ICER) for cinacalcet was $61,705 per life-year and $79,562 per quality-adjusted life-year (QALY) gained using the covariate-adjusted ITT analysis. Probabilistic sensitivity analysis suggested a 73.2% chance of the ICER being below a willingness-to-pay threshold of $100,000. Treatment effects from unadjusted ITT analysis yielded an ICER of $115,876 per QALY. The model was most sensitive to the treatment effect on mortality. Conclusions: In the unadjusted ITT analysis, cinacalcet does not represent a cost- effective use of health care resources when applying a willingness-to-pay threshold of $100,000 per QALY. When using the covariate-adjusted ITT treatment effect, which represents the least biased estimate, however, cinacalcet is a cost-effective therapy for patients with moderate-to-severe sHPT on hemodialysis.

Item Type:Articles
Additional Information:The EVOLVE trial and the economics analysis presented in this article were funded by Amgen Inc.
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew
Authors: Belozeroff, V., Chertow, G. M., Graham, C. N., Dehmel, B., Parfrey, P. S., and Briggs, A. H.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Value in Health
Published Online:09 October 2015

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