Cost-Effectiveness and Estimated Health Benefits of Treating Patients with Vitamin D in Pre-Dialysis

Snyder Sophie (), Hollenbeak Christopher S., Kalantar-Zadeh Kamyar, Gitlin Matthew and Ashfaq Akhtar
Additional contact information
Snyder Sophie: BluePath Solutions, 10951 W. Pico Blvd. Suite 120 Los Angeles, CA, USA
Hollenbeak Christopher S.: The Pennsylvania State University, Department of Health Policy and Administration, University Park, PA, USA
Kalantar-Zadeh Kamyar: School of Medicine, University of California, Irvine, CA, USA
Gitlin Matthew: BluePath Solutions, 10951 W. Pico Blvd. Suite 120 Los Angeles, CA, USA
Ashfaq Akhtar: Clinical R & D and Medical Affairs, Renal Division, Opko Pharmaceuticals, Miami, FL, USA

Forum for Health Economics & Policy, 2020, vol. 23, issue 1, 15

Abstract: Background The optimal timing of treatment with vitamin D therapy for patients with chronic kidney disease (CKD), vitamin D insufficiency, and secondary hyperparathyroidism (SHPT) is a pressing question in nephrology with economic and patient outcome implications. Objective The objective of this study was to estimate the cost-effectiveness of earlier vitamin D treatment in CKD patients not on dialysis with vitamin D insufficiency and SHPT. Design A cost-effectiveness analysis based on a Markov model of CKD progression was developed from the Medicare perspective. The model follows a hypothetical cohort of 1000 Stage 3 or 4 CKD patients over a 5-year time horizon. The intervention was vitamin D therapy initiated in CKD stages 3 or 4 through CKD stage 5/end-stage renal disease (ESRD) versus initiation in CKD stage 5/ESRD only. The outcomes of interest were cardiovascular (CV) events averted, fractures averted, time in CKD stage 5/ESRD, mortality, quality-adjusted life years (QALYs), and costs associated with clinical events and CKD stage. Results Vitamin D treatment in CKD stages 3 and 4 was a dominant strategy when compared to waiting to treat until CKD stage 5/ESRD. Total cost savings associated with treatment during CKD stages 3 and 4, compared to waiting until CKD stage 5/ESRD, was estimated to be $19.9 million. The model estimated that early treatment results in 159 averted CV events, 5 averted fractures, 269 fewer patient-years in CKD stage 5, 41 fewer deaths, and 191 additional QALYs. Conclusions Initiating vitamin D therapy in CKD stages 3 or 4 appears to be cost-effective, largely driven by the annual costs of care by CKD stage, CV event costs, and risks of hypercalcemia. Further research demonstrating causal relationships between vitamin D therapy and patient outcomes is needed to inform decision making regarding vitamin D therapy timing.

Keywords: 25-hydroxyvitamin D; cardiovascular disease; chronic kidney disease (CKD); cost-effectiveness; disease progression; economic analysis; end-stage renal disease (ESRD); fracture; health care costs; parathyroid hormone (PTH); pre-dialysis care; secondary hyperparathyroidism (SHPT) (search for similar items in EconPapers)
Date: 2020
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DOI: 10.1515/fhep-2019-0020

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