Abstract
BackgroundPatients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require dialysis are at increased risk for cardiovascular events and bone fractures. To assist in economic evaluations, this study aimed to estimate the disutility of these events beyond the impact of CKD and SHPT.MethodsA basic one-year health state was developed describing CKD and SHPT requiring dialysis. Further health states added acute events (cardiovascular events, fractures, and surgical procedures) or chronic post-event effects. Acute health states described a year including an event, and chronic health states described a year subsequent to an event. General population participants in Canada completed time trade-off interviews from which utilities were derived. Pairwise comparisons were made between the basic state and event, and between comparable health states.ResultsA total of 199 participants (54.8% female; mean age = 46.3 years) completed interviews. Each health state had ≥130 valuations. The mean (SD) utility of the basic health state was 0.60 (0.34). For acute events, mean utility differences versus the basic state were: myocardial infarction, −0.06; unstable angina, −0.05; peripheral vascular disease (PVD) with amputation, −0.33; PVD without amputation, −0.11; heart failure, −0.14; stroke, −0.30; hip fracture, −0.14; arm fracture, −0.04; parathyroidectomy, +0.02; kidney transplant, +0.06. Disutilities for chronic health states were: stable angina, −0.09; stroke, −0.27; PVD with amputation, −0.30; PVD without amputation, −0.12; heart failure, −0.14.ConclusionsCardiovascular events and fractures were associated with lower utility scores, suggesting a perceived decrease in quality of life beyond the impact of CKD and SHPT.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-015-0266-9) contains supplementary material, which is available to authorized users.
Highlights
Patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require dialysis are at increased risk for cardiovascular events and bone fractures
Most stage 5 CKD patients have abnormal blood mineral levels and elevated levels of parathyroid hormone (PTH), a condition known as secondary hyperparathyroidism
The objective of the current study was to obtain utility values associated with cardiovascular events and fractures in the context of SHPT and CKD requiring dialysis
Summary
Patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require dialysis are at increased risk for cardiovascular events and bone fractures. Most stage 5 CKD patients have abnormal blood mineral levels and elevated levels of parathyroid hormone (PTH), a condition known as secondary hyperparathyroidism (SHPT) [4,5,6]. Patients with CKD and SHPT typically experience a wide range of symptoms such as bone and joint pain, as well as psychological symptoms that are associated with lower health-related quality of life [7,8,9,10,11]. CKD and SHPT are associated with increased risk of serious cardiovascular and bone-related complications.
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