OBJECTIVES:

Secondary hyperparathyroidism (SHPT) is a progressive disorder in chronic kidney disease (CKD) and is associated with adverse outcomes (e.g. cardiovascular diseases (CVD), fractures, faster progression to dialysis). To date, data on the economic burden of SHPT from the German perspective is lacking.

METHODS:

Data from a large German insurance claims database was used to identify CKD stage 3 (CKD3) and 4 (CKD4) patients, stratified by the occurrence of incident SHPT. Patients with SHPT were individually matched 1:1 to non-SHPT patients with the same CKD stage using propensity scores. Index date was the first SHPT diagnosis quarter in the SHPT cohorts, and a randomly chosen quarter with a CKD diagnosis within the CKD-only cohorts. Patients undergoing dialysis or kidney transplantation prior to the index were excluded. Matched groups were compared for healthcare resource utilization and costs during a two-year follow-up period.

RESULTS:

Overall, 1,156 incident SHPT CKD3 and 517 SHPT CKD4 patients as well as their respective matches were identified. Mean rates of all-cause hospitalizations were significantly higher among SHPT patients (2.7 vs. 2.0 p<0.01 CKD3, 2.8 vs. 1.5 p<0.01 CKD4) during follow-up. Rates of CVD-related hospitalizations were also higher among SHPT patients (0.8 vs. 0.6 p<0.01 CKD3, 1.1 vs 0.5 p<0.01 CKD4). Similarly, the rates of outpatient encounters were significantly higher among the SHPT cohorts (95.0 vs. 64.3 p<0.01 CKD3, 101.4 vs. 49.8 p<0.01 CKD4). Consequently, average all-cause healthcare costs were significantly higher in SHPT vs. non-SHPT patients (€19,477 vs €15.115 p<0.01 CKD3, €25,921 vs. €12,265 p<0.01 CKD4).

CONCLUSIONS:

Incident SHPT patients with CKD3/CKD4 presented with significantly higher healthcare resource utilization and healthcare costs in comparison to CKD3/CKD4 patients without SHPT. The findings highlight the need for new treatment options to mitigate the burden of disease for SHPT patients and on the healthcare system to possibly offset costs.