EXTON, Pa.—The new dialysis bundled payment system has started to change a number of key areas in the management of secondary hyperparathyroidism in the dialysis setting, seemingly in an effort to save costs, according to a new report from BioTrends Research Group.
The report “ChartTrends: Bone and Mineral in Dialysis (US)” is a syndicated annual report series, in which over 200 nephrologists provide patient chart data on 1,000 dialysis patients to uncover the actual management related to bone and mineral metabolism.
There have been significant brand shifts among hemodialysis patients treated with active vitamin D compared to last year. Abbott’s Zemplar has been hit the hardest and the older-generation vitamin D and Calcijex has benefited the most, according to the BioTrends survey.
Another big change from last year is the percent of active vitamin D-treated hemodialysis patients on oral versus intravenous (IV) formulations. While IV remains the formulation for the majority of hemodialysis patients, there has been a more than seven-fold increase in the percent of hemodialysis patients treated with oral active vitamin D formulations compared to the prior year, according to BioTrends.
There are differences, however, based on where patients receive dialysis (e.g., large dialysis organizations, small and medium chains, and independent units), with certain units more apt to try oral active vitamin D compared to others, BioTrends reported. While overall treatment prevalence is similar to last year, the mean weekly dose for both Zemplar IV and Genzyme’s Hectorol IV has decreased.
Phosphate binders and Amgen’s Sensipar, both excluded from the bundle until 2014, appear to be less impacted by bundling to date, according to BioTrends. Although some expected Sensipar to benefit from its bundle exclusion, the percent of hemodialysis patients treated with Sensipar has not changed compared to the prior year. This may be due in part to the liberalization of PTH goals implemented by a number of dialysis units. While phosphate binder brand use and dose have not changed compared to last year, the BioTrends audit continues to see declining trends in the percent of hemodialysis patients treated with phosphate binders.
