Endocrine Abstracts

Objective: To evaluate the efficacy of medical management of hyperparathyroidism and evaluate the financial and healthcare impact of delay in surgical intervention within a district general hospital. To assess the duration of use of cinacalcet prescriptions, compare wait times for surgery and assess the service needs.

Method: We retrospectively evaluated all patients with primary hyperparathyroidism who received cinacalcet prescriptions from January 2021 to December 2022. We measured the duration and appropriateness of cinacalcet use, evaluated the patients’ eligibility for parathyroid surgery, compared and contrasted the current wait time for surgery against national standards, and reported the complications of hypercalcaemia alongside additional cost related to potentially avoidable inpatient admission due to hypercalcaemia.

Results: We evaluated 62 patients who received cinacalcet prescriptions. 32 (52%) patients were offered surgery (age 65 ± 12.5 years), out of which only 13 patients underwent parathyroidectomy. The average waiting time for parathyroid surgery was 22 months (range 8 to 43 months) from the point of the initial contact in surgical outpatient clinic. The mean duration of use of cinacalcet was 20 ± 6 months for those awaiting surgery and 15 ± 9 months for those not suitable for surgical intervention. Reduction in bone mineral density was observed in 55% of patients, renal stones in 17% and fragility fractures in 14.5%. 22 of the 62 patients (35%) required inpatient admission due to hypercalcaemia totalling 146 inpatient hospital days.

Conclusion: Prolonged delay and longer waiting times for definitive surgical intervention has resulted in higher cost and potential adverse outcomes in patients. Based on current data, we created a need for an MDT service to improve care for patients with the longest wait times in order to improve patient outcomes, reduce risk and improve the efficacy of the service.