Methods: We developed a probabilistic Markov model to simulate the effect of cinacalcet
on Ca, P and PTH levels in dialysis patients with SHPT, based on data from a European, multicentre, open-label study. The model then correlated these levels with mortality and morbidity (CV events, fractures and parathyroidectomies) using data from the literature, and incorporated Italian data for dialysis, drugs and management of events according to the national cost structure. The simulation horizon was patient lifetime; simulated treatment alternatives were standard treatment (mainly vitamin D sterols and phosphate binders) and cinacalcet + standard treatment. A 3.5% discount rate was applied to life expectancy (LE), quality-adjusted life-expectancy
(QALE), costs and times below the upper ranges (time in range [TiR]) recommended by the National Kidney Foundation Kidney Disease Outcomes 3-deazaneplanocin A inhibitor Quality initiative for PTH, Ca, P and Ca x P. Utilities were derived from the published literature and took into account dialysis and the impairment of quality of life due to the occurrence of CV events and fractures. Costs were evaluated in year 2009 values from the perspective of the Italian National Healthcare System.
Results: Baseline results were calculated with 10 000 iterations. Compared with standard treatment alone, addition of cinacalcet was associated with a mean (SD) increase in TiR of Vorinostat chemical structure 5.26 (6.59), 3.63 (6.87), 1.70 (6.66) and 2.68 (5.55) discounted patient-years for PTH, Ca and P, respectively, and combined PTH, Ca, P and Ca x P. Cinacalcet increased LE by 1.20 (3.75) life-years (LYs) and QALE by 0.89 (2.59) QALYs. When including the cost for dialysis, the incremental cost-effectiveness ratio (ICER) was (sic)50 012 per LY and (sic)67 361 per QALY, while, if dialysis costs were not included, the ICER was (sic)23 473 per LY and (sic)31 616 per QALY.
Conclusions: The results suggest that cinacalcet
treatment could be considered cost effective for treatment of SHPT in the Italian healthcare setting, but further investigations are needed to confirm these findings.”
“Venous anatomy frequently impairs placement of the left ventricular (LV) lead. In some cases, the wire will not advance into the vein and in others wire position is lost as the lead is advanced. This article describes Bcl-2 inhibitor clinical trial how a commonly available goose neck snare is used to gain access to the distal end of the wire as it re-enters the coronary sinus retrograde via collaterals through an adjacent vein. The snare is advanced into the coronary sinus through the same catheter as the wire. The snare opens perpendicular to the long axis of the coronary sinus due to which the wire must pass through the open loop, provided the diameter of the snare is approximately the same as the coronary sinus. Thus no time-consuming manipulation of the snare is required.