Variability in Cinacalcet Prescription across US Hemodialysis Facilities.
Black or African American
/ statistics & numerical data
Age Factors
Aged
Aged, 80 and over
Ambulatory Care Facilities
/ statistics & numerical data
Calcimimetic Agents
/ therapeutic use
Cinacalcet
/ therapeutic use
Cross-Sectional Studies
Drug Prescriptions
/ statistics & numerical data
Humans
Kidney Failure, Chronic
/ therapy
Middle Aged
Renal Dialysis
Time Factors
United States
Calcimimetics
Cinacalcet Hydrochloride
Cross-Sectional Studies
DOPPS
Diagnosis-Related Groups
Hyperparathyroidism, Secondary
Kidney Failure, Chronic
Medicare
Motivation
Prevalence
Prospective Payment System
parathyroid hormone
public policy
renal dialysis
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 02 2019
07 02 2019
Historique:
received:
08
08
2018
accepted:
12
12
2018
pubmed:
23
1
2019
medline:
14
5
2020
entrez:
23
1
2019
Statut:
ppublish
Résumé
Calcimimetic drugs used to treat secondary hyperparathyroidism are being considered for inclusion in the Medicare ESRD Prospective Payment System bundle after an evaluation period. Understanding of utilization patterns of calcimimetics across dialysis facilities may help align financial incentives with clinical objectives. Our study's purpose was to describe the distribution of cinacalcet prescription across United States hemodialysis facilities and to explore factors that may influence cinacalcet utilization. We used monthly cross-sectional data from the Dialysis Outcomes and Practice Patterns Study in 2014 to characterize the distribution of cinacalcet prescription across 203 United States hemodialysis facilities (10,521 patients). On the basis of associations with parathyroid hormone levels from patient-level analyses, we used linear mixed-effects regressions to estimate the associations between three facility-level exposures (black race, <65 years old, and having ≥3 years on dialysis [vintage]) and the prevalence of cinacalcet prescription, adjusting for facility- and patient-level potential confounders. The mean percentage of patients in each facility with cinacalcet prescription was 23% in June 2014 (median, 22%; interquartile range, 13%-30%). Adjusted for facility-level and nonexposure patient-level variables, the difference in prevalence of cinacalcet prescription between facilities with the highest and lowest quartiles of percentage of black patients was 7.8% (95% confidence interval [95% CI], 0.8% to 14.8%; Facilities treating more patients who are black, under age 65 years, and having dialysis vintage ≥3 years have higher average levels of cinacalcet prescription. However, these differences were strongly attenuated after accounting for the unbalanced distributions of these patient case-mix variables.
Sections du résumé
BACKGROUND AND OBJECTIVES
Calcimimetic drugs used to treat secondary hyperparathyroidism are being considered for inclusion in the Medicare ESRD Prospective Payment System bundle after an evaluation period. Understanding of utilization patterns of calcimimetics across dialysis facilities may help align financial incentives with clinical objectives. Our study's purpose was to describe the distribution of cinacalcet prescription across United States hemodialysis facilities and to explore factors that may influence cinacalcet utilization.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We used monthly cross-sectional data from the Dialysis Outcomes and Practice Patterns Study in 2014 to characterize the distribution of cinacalcet prescription across 203 United States hemodialysis facilities (10,521 patients). On the basis of associations with parathyroid hormone levels from patient-level analyses, we used linear mixed-effects regressions to estimate the associations between three facility-level exposures (black race, <65 years old, and having ≥3 years on dialysis [vintage]) and the prevalence of cinacalcet prescription, adjusting for facility- and patient-level potential confounders.
RESULTS
The mean percentage of patients in each facility with cinacalcet prescription was 23% in June 2014 (median, 22%; interquartile range, 13%-30%). Adjusted for facility-level and nonexposure patient-level variables, the difference in prevalence of cinacalcet prescription between facilities with the highest and lowest quartiles of percentage of black patients was 7.8% (95% confidence interval [95% CI], 0.8% to 14.8%;
CONCLUSIONS
Facilities treating more patients who are black, under age 65 years, and having dialysis vintage ≥3 years have higher average levels of cinacalcet prescription. However, these differences were strongly attenuated after accounting for the unbalanced distributions of these patient case-mix variables.
Identifiants
pubmed: 30665922
pii: 01277230-201902000-00013
doi: 10.2215/CJN.09550818
pmc: PMC6390908
doi:
Substances chimiques
Calcimimetic Agents
0
Cinacalcet
UAZ6V7728S
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
241-249Subventions
Organisme : Department of Health
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
Références
Leavitt MO; Secretary of Health and Human Services: Report to Congress: A Design for a Bundled End Stage Renal Disease Prospective Payment System, 2008. Available at: https://www.cms.gov/Medicare/End-Stage-Renal-Disease/ESRDGeneralInformation/Downloads/ESRDReportToCongress.pdf . Accessed January 3, 2019
Medicare Payment Advisory Commission (MedPAC): Outpatient Dialysis Services Payment System, 2017. Available at: http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_17_dialysis_finald8a311adfa9-c665e80adff00009edf9c.pdf?sfvrsn=0 Accessed January 3, 2019
Kidney Epidemiology and Cost Center: Methodology for Developing a Basic Case Mix Adjustment for the Medicare ESRD Prospective Payment System, 2015. Available at: https://kecc.sph.umich.edu/sites/default/files/attachments/publications/Basic_Case_Mix_Methods_appendices%204_01_05.pdf . Accessed January 3, 2019
Hirth RA, Turenne MN, Nahra TA, Segal JH, Sleeman KK, Zhang W, Wheeler JRC: Analyses to Inform the Design and Implementation of the End-Stage Renal Disease Prospective Payment System, 2015. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Downloads/ESRD-PPS-Analysis.pdf . Accessed January 3, 2019
Weiner DE, Watnick SG: The 2009 proposed rule for prospective ESRD payment: Historical perspectives and public policies--bundle up! Am J Kidney Dis 55: 217–222, 201020116682
Nissenson AR, Mayne TJ, Krishnan M: The 2009 proposed rule for prospective ESRD payment: Perspectives from a large dialysis organization. Am J Kidney Dis 55: 223–226, 201020116683
Bhat JG, Bhat P: The 2009 proposed rule for prospective ESRD payment: Perspectives from a for-profit small dialysis organization. Am J Kidney Dis 55: 231–233, 201020116686
Centers for Medicare & Medicaid Services (CMS): End Stage Renal Disease (ESRD) Prospective Payment System (PPS), 2018. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/index.html . Accessed June 28, 2018
Block GA, Martin KJ, de Francisco AL, Turner SA, Avram MM, Suranyi MG, Hercz G, Cunningham J, Abu-Alfa AK, Messa P, Coyne DW, Locatelli F, Cohen RM, Evenepoel P, Moe SM, Fournier A, Braun J, McCary LC, Zani VJ, Olson KA, Drüeke TB, Goodman WG: Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350: 1516–1525, 200415071126
Block GA, Bushinsky DA, Cunningham J, Drueke TB, Ketteler M, Kewalramani R, Martin KJ, Mix TC, Moe SM, Patel UD, Silver J, Spiegel DM, Sterling L, Walsh L, Chertow GM: Effect of etelcalcetide vs placebo on serum parathyroid hormone in patients receiving hemodialysis with secondary hyperparathyroidism: Two randomized clinical trials. JAMA 317: 146–155, 201728097355
Block GA, Bushinsky DA, Cheng S, Cunningham J, Dehmel B, Drueke TB, Ketteler M, Kewalramani R, Martin KJ, Moe SM, Patel UD, Silver J, Sun Y, Wang H, Chertow GM: Effect of etelcalcetide vs cinacalcet on serum parathyroid hormone in patients receiving hemodialysis with secondary hyperparathyroidism: A randomized clinical trial. JAMA 317: 156–164, 201728097356
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group: KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7: 1–59, 2017
Arbor Research Collaborative for Health: DOPPS Practice Monitor, 2018. Available at: http://www.dopps.org/dpm . Accessed June 28, 2018
Hirth RA, Turenne MN, Nahra TA, Segal JH, Sleeman KK, Zhang W, Wheeler JRC: Analyses to Support the 2016 Refinements to the End-Stage Renal Disease Prospective Payment System, 2016. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Downloads/Analyses-to-Support-the-ESRD-PPS-2016.pdf . Accessed June 28, 2018
United States Food and Drug Administration: Parsabiv (Etelcalcetide) Injection Approval Package, 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/208325Orig1s000Approv.pdf . Accessed June 28, 2018
Kilpatrick RD, Newsome BB, Zaun D, Liu J, Solid CA, Nieman K, St Peter WL: Evaluating real-world use of cinacalcet and biochemical response to therapy in US hemodialysis patients. Am J Nephrol 37: 389–398, 201323548469
Newsome BB, Kilpatrick RD, Liu J, Zaun D, Solid CA, Nieman K, St Peter WL: Racial differences in clinical use of cinacalcet in a large population of hemodialysis patients. Am J Nephrol 38: 104–114, 201323899621
St Peter WL, Li Q, Liu J, Persky M, Nieman K, Arko C, Block GA: Cinacalcet use patterns and effect on laboratory values and other medications in a large dialysis organization, 2004 through 2006. Clin J Am Soc Nephrol 4: 354–360, 200919129318
Young EW, Goodkin DA, Mapes DL, Port FK, Keen ML, Chen K, Maroni BL, Wolfe RA, Held PJ: The Dialysis Outcomes and Practice Patterns Study (DOPPS): An international hemodialysis study. Kidney Int 57[Suppl 74]: S74–S81, 2000
Pisoni RL, Bragg-Gresham JL, Young EW, Akizawa T, Asano Y, Locatelli F, Bommer J, Cruz JM, Kerr PG, Mendelssohn DC, Held PJ, Port FK: Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 44: 94–111, 200415211443
Robinson B, Fuller D, Zinsser D, Albert J, Gillespie B, Tentori F, Turenne M, Port F, Pisoni R: The Dialysis Outcomes and Practice Patterns Study (DOPPS) practice monitor: Rationale and methods for an initiative to monitor the new US bundled dialysis payment system. Am J Kidney Dis 57: 822–831, 201121530036
Rural Health Research Center: RUCA Data Overview, 2005. Available at: http://depts.washington.edu/uwruca/ruca-data.php . Accessed October 8, 2018
Centers for Medicare and Medicaid Services: ESRD PPS Patient-Level Adjustments, 2016. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Patient-Level-Adjustments.html . Accessed June 28, 2018
Mehrotra R, Supasyndh O, Berman N, Kaysen G, Hurst L, Leonardi M, Das D, Kopple JD: Age-related decline in serum parathyroid hormone in maintenance hemodialysis patients is independent of inflammation and dietary nutrient intake. J Ren Nutr 14: 134–142, 200415232791
Danese MD, Halperin M, Lowe KA, Bradbury BD, Do TP, Block GA: Refining the definition of clinically important mineral and bone disorder in hemodialysis patients. Nephrol Dial Transplant 30: 1336–1344, 201525817224
Roach JL, Turenne MN, Hirth RA, Wheeler JRC, Sleeman KS, Messana JM: Using race as a case-mix adjustment factor in a renal dialysis payment system: Potential and pitfalls. Am J Kidney Dis 56: 928–936, 201020888100
Renal Physicians Association: ESRD Bundling Comment - Renal Physicians Association, 2009. Available at: http://www.renalmd.org/general/custom.asp?page=ESRDBundlingComment . Accessed February 20, 2018
Gupta A, Kallenbach LR, Zasuwa G, Divine GW: Race is a major determinant of secondary hyperparathyroidism in uremic patients. J Am Soc Nephrol 11: 330–334, 200010665940
Omije D, Norris K, Wang J, Pan D, Kermah D, Gupta A: Race is a major determinant of secondary hyperparathyroidism in uremic patients: Comparative study of Blacks and Hispanics. Clin Nephrol 70: 312–318, 200818826856
Robinson BM, Fuller DS, Bieber BA, Turenne MN, Pisoni RL: The DOPPS practice monitor for US dialysis care: Trends through April 2011. Am J Kidney Dis 59: 309–312, 201222169621
Turenne MN, Cope EL, Porenta S, Mukhopadhyay P, Fuller DS, Pearson JM, Dahlerus C, Lantz B, Tentori F, Robinson BM: Has dialysis payment reform led to initial racial disparities in anemia and mineral metabolism management? J Am Soc Nephrol 26: 754–764, 201525300289
Brunelli SM, Monda KL, Burkart JM, Gitlin M, Neumann PJ, Park GS, Symonian-Silver M, Yue S, Bradbury BD, Rubin RJ: Early trends from the Study to Evaluate the Prospective Payment System Impact on Small Dialysis Organizations (STEPPS). Am J Kidney Dis 61: 947–956, 201323332991
Spoendlin J, Schneeweiss S, Tsacogianis T, Paik JM, Fischer MA, Kim SC, Desai RJ. Association of Medicare’s bundled payment reform with changes in use of vitamin D among patients receiving maintenance hemodialysis: An interrupted time-series analysis. Am J Kidney Dis 72: 178–187, 2018
Chou JW, Chertow GM, Lakdawalla DN, Yehoshua A, Belozeroff V: Health Affairs Blog: Bundled Payments: Balancing Incentives, Quality, And Affordability. December 20, 2017. Available at: https://www.healthaffairs.org/do/10.1377/hblog20171215.648122/full/ . Accessed June 28, 2018