Parathyroidectomy costs more to treat secondary hyperparathyroidism (SHPT) in patients on hemodialysis than it does to treat primary hyperparathyroidism (PHPT), according to new study findings presented during the National Kidney Foundation’s 2020 live-virtual Spring Clinical Meetings.

In a review of 4 recent US studies, parathyroidectomy (PTx) costs per SHPT patient ranged from $5251 for physician care only to $21,496 for total inpatient hospital charges, excluding costs for complications, Hamza Alshannaq, MD, MPh, of the University of Cincinnati and colleagues reported. PTx costs were lower for a mixed cohort of PHPT and SHPT patients: a maximum of $16,987 per patient.

The investigators also examined readmission and reoperation rates in 11 studies that included 15,183 PTx patients. Overall, 3.3% of patients were readmitted within 10 days of surgery, 7.9% to 23.8% within 30 days, 25% within 90 days, and 63.9% within the first year. The most common causes for readmission were hypocalcemia and hungry bone syndrome. Reoperation rates ranged from 3.3% to 26% depending on surgical modality and length of follow up. Persistent or recurrent SHPT and hematoma were the top causes of reoperation.

Patients with SHPT generally had higher mortality, morbidity, and complication rates than those with PHPT, the investigators reported. In one study of 30-day outcomes, for example, mortality was 0.84% vs 0.14%, reoperation 7% vs 1.3%, readmission 7.9% vs 1.2%, and mean length of hospital stay 3.5 vs 0.9 days for SHPT and PHPT patients, respectively.


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“While the PTx surgical procedures are very similar in PHPT and SHPT, the cost of PTx in SHPT is significantly higher due to difference in rates of mortality, readmission, and reoperation,” Dr Alshannaq’s team stated.

The investigators noted that their study provides a historic view of the rates and costs of PTx, and “results could be used to analyze and model how the Medicare CMS policy changes may affect use of calcimimetics and practice patterns.”

Disclosure: This study was supported by Amgen. Please see the original reference for a full list of authors’ disclosures.

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Reference

Alshannaq H, Rossetti S, Bhatt N, Desai P. Parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism: Systematic review of prevalence, costs & rates of readmission and reoperation. Poster presented at the National Kidney Foundation’s 2020 live-virtual Spring Clinical Meetings held March 26 to 29. ePoster 205.