ECE2024 Poster Presentations Calcium and Bone (36 abstracts)
A pharmacoeconomic analysis from Italian guidelines for the management of sporadic primary hyperparathyroidism
Roberto Attanasio1, Irene Samperi2, Alessandro Scoppola3, Agostino Paoletta4, Roberto Novizio5, Fabio Vescini6, Giorgio Borretta7, Iacopo Chiodini8, Enrico Papini9, Agnese Persichetti10, Michele Basile11, Marco Boniardi12, Marina Carotti13, Elena Castellano7, Cristiana Cipriani14, Cristina Eller-Vainicher15, Sandro Giannini16, Maurizio Iacobone17, Antonio/////Stefano Salcuni6, Federica Saponaro18, Stefano Spiezia19, Annibale Versari20, Guido Zavatta21, Zuzana Mitrova22, Alexia Giovannazzi23, Rosella Saulle22, Simona Vecchi22, Debora Antonini11, Giorgio Calò24, Filomena Cetani25, Luisella Cianferotti26, Sabrina Corbetta27, Maria Luisa De Rimini28, Alberto Falchetti29, Giovanni Iannetti30, Stefano Laureti31, Celestino/////Pio Lombardi32, Bruno Madeo33, Claudio Marcocci25, Sandro Mazzaferro34, Vittorio Miele35, Salvatore Minisola36, Andrea Palermo37, Jessica Pepe13, Laura Tonzar11, Alfredo Scillitani38, Franco Grimaldi39, Renato Cozzi40 & Roberto Attanasio1
1AME Scientific Committee, Milan, Italy; 2SSD of Diabetology and Metabolic Diseases - Azienda Sanitaria Locale Novara, Novara, Italy; 3Endocrinology, Ospedale Santo Spirito, rome, Italy; 4Endocrinology,, ULSS6 Euganea, Padua, Italy; 5Endocrinology and Metabolism, Agostino Gemelli University Polyclinic (IRCCS), Catholic University of the Sacred Heart, Rome, Italy; 6Endocrinology Unit, Azienda Sanitaria-Universitaria Friuli Centrale, P.O. Santa Maria della Misericordia, Udine, Italy; 7Department of Endocrinology, Diabetes and Metabolism, Ospedale Santa Croce and Carle Hospital, Cuneo, Italy; 8Endocrinology Department, ASST Grande Ospedale Metropolitano di Niguarda, Milan, Italy; 9Endocrinology, ospedale Regina Apostolorum, Rome, Italy; 10Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy; 11High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy; 12General Oncologic and Mini-invasive Surgery Department, ASST Grande Ospedale Metropolitano di Niguarda, Mialn, Italy; 13Department of Radiology, AOU delle Marche, Ancona, Università Politecnica delle Marche, Ancona, Italy; 14Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy; 15Endocrinology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 16Clinica Medica 1, Department of Medicine, University of Padova, Padua, Italy; 17Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; 18Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University Pisa, pisa, Italy; 19Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, Naples, naples, Italy; 20Nuclear Medicine, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy; 21Division of Endocrinology and Diabetes Prevention and Care, IRCCS AOU di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, bologna, Italy; 22Department of Epidemiology, Lazio Region Health Service, Rome, Italy; 23Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy; 24SIUEC President, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; 25Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 26Bone Metabolic Diseases Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, AOU Careggi, Florence, Italy; 27Bone Metabolism and Diabetes, IRCCS Istituto Auxologico Italiano, Milan, Italy; 28AIMN President, Nuclear Medicine Unit, AORN Ospedali dei Colli, Naples, Naples, Italy; 29Laboratory of Experimental Clinical Research on Bone Metabolism, Istituto Auxologico Italiano IRCCS, Milan, Italy; 30SIUMB President, Ultrasound Unit, S. Spirito Hospital, Pescara, Italy; 31General Practitioner, USL Umbria 1, Perugia, Italy; 32Endocrine Surgery, Ospedale Gemelli, Rome, Italy; 33Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; 34Nephrology Unit at Policlinico Umberto I Hospital and Department of Translation and Precision Medicine, Sapienza University of Rome, Rome, Italy; 35Department of Emergency Radiology, Careggi University Hospital, Florence, Italy; 36UOC Medicina Interna A, Malattie Metaboliche dell’Osso, Ambulatorio Osteoporosi e Osteopatie Fragilizzanti, Sapienza University of Rome, Rome, Italy; 37Unit of Thyroid and Bone-Metabolic Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; 38Unit of Endocrinology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, San Giovanni Rotondo, Italy; 39AME past President, Udine, Italy; 40AME president, Milan, Italy
Background: Primary hyperparathyroidism (PHPT) is the third most common endocrine disease and the most frequent cause of hypercalcemia in outpatients with an estimated incidence of 20/100 000/year and prevalence in the general population of 0.1%–0.4%. Parathyroidectomy (PTX) is the only treatment that can achieve PHPT cure but a few medications can be used to control calcium levels, bone and kidney impairment.
Aims: 1) To assess costs associated with the different treatment options for PHPT (PTX, cinacalcet, bisphosphonates, denosumab, and thiazides); 2) To assess the cost-utility profile of the alternatives to inform the policy making; 3) To provide comprehensive recommendations for the most cost-utility and efficient approaches to managing PHPT in the Italian healthcare setting.
Method: A systematic literature review and a survey among the panel were performed to address drivers that contribute to each therapeutic option. Economic analysis was carried out with Activity Based Costing methodology.
Results: The estimated cost of PTX arm amounts to an average of € 4588. This amount includes: diagnostic assessment, surgery, post-operative follow-up, indirect costs for patient and caregiver, and costs due to the acute and chronic post-operative complications (added for the fraction of patients undergoing those complications). Taking into account the expected additional costs in the first year for the complementary services, the total expenditure is € 5714. In the case of non-surgical policy, the estimated annual cost is a mean € 197 and € 953 for surveillance and drug treatments (including cost of drugs and follow-up in the proportion of patients treated with each drug), respectively. As surgery for sporadic PHPT is performed at a mean age of 55 years, the residual time horizon points to about 30 years. The estimated cost for the same 30-year time horizon amounts to € 28 590 for the patients followed up with medications and to € 5910 for surveillance alone (Table 1).
| Approach | Annual cost | 30-year cost |
| Surgery | € 5116 | € 5116 |
| Surveillance | € 197 | € 5910 |
| Medication | € 953 | € 28 590 |
Conclusions: Despite limitations of this analysis, we can believe that the 30-year excess costs for patients who are managed pharmacologically in comparison to those who are surgically treated is € 23 474 (28 590 – 5116). If we assume that at least 10% of patients currently treated pharmacologically (estimated to be near 1500 in Italy) could be switched to surgical strategy, we can estimate an annual saving for National Health System exceeding € 3 500 000 (23 474×150=3 521 100).
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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