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Open Access Highly Accessed Research article

Effect of cinacalcet availability and formulary listing on parathyroidectomy rate trends

Jean-Philippe Lafrance123*, Héloïse Cardinal24, Martine Leblanc23, François Madore25, Vincent Pichette123, Louise Roy24 and Jacques Le Lorier26

Author affiliations

1 Centre de recherche Hôpital Maisonneuve-Rosemont, Montréal, Canada

2 Département de Médecine, Université de Montréal, Montréal, Canada

3 Service de néphrologie, Hôpital Maisonneuve-Rosemont, 5415, boul. de l’Assomption, Montréal, QC, H1T 2M4, Canada

4 Service de néphrologie, Centre hospitalier de l’Université de Montréal, Montréal, Canada

5 Service de néphrologie, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada

6 Centre de recherche Centre hospitalier de l’Université de Montréal, Montréal, Canada

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Citation and License

BMC Nephrology 2013, 14:100  doi:10.1186/1471-2369-14-100

Published: 3 May 2013

Abstract

Background

Recent trends in parathyroidectomy rates are not known. Our objective was to investigate the trend in parathyroidectomy rates between 2001 and 2010, and to evaluate if the availability and reimbursement of cinacalcet modified that trend.

Methods

Using a provincial administrative database, we included all adult patients receiving chronic dialysis treatments between 2001 and 2010 (incident and prevalent) in a time series analysis. The effect of cinacalcet availability on parathyroidectomy bimonthly rates was modeled using an ARIMA intervention model using different cut-off dates: September 2004 (Health Canada cinacalcet approval), January 2005, June 2005, January 2006, June 2006 (date of cinacalcet provincial reimbursement), and January 2007.

Results

A total of 12 795 chronic dialysis patients (mean age 64 years, 39% female, 82% hemodialysis) were followed for a mean follow-up of 3.3 years. During follow-up, 267 parathyroidectomies were identified, translating to an average rate of 7.0 per 1000 person-years. The average parathyroidectomy rate before cinacalcet availability was 11.4 /1000 person-years, and 3.6 /1000 person-years after cinacalcet public formulary listing. Only January 2006 as an intervention date in the ARIMA model was associated with a change in parathyroidectomy rates (estimate: -5.58, p = 0.03). Other intervention dates were not associated with lower parathyroidectomy rates.

Conclusions

A reduction in rates of parathyroidectomy was found after January 2006, corresponding to cinacalcet availability. However, decreased rates may be due to other factors occurring simultaneously with cinacalcet introduction and further studies are needed to confirm these findings.

Keywords:
Parathyroidectomy; Hyperparathyroidism, Secondary; Calcimimetic agents; Renal dialysis; Epidemiologic studies