ANALYSIS OF COSTS RELATED TO THE DRUG TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN CHRONIC KIDNEY DISEASE AFTER PARATHYROIDECTOMY: COMPARISON OF THE EFFECTIVENESS OF DIFFERENT OPERATIVE TECHNIQUES.

• Grant number: 21/11724-6
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: December 01, 2022
• End date: November 30, 2023
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Fábio Luiz de Menezes Montenegro
• Grantee: Gabriel Mattucci Domingues Pereira
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Currently, secondary hyperparathyroidism (SHPT) affects about 44% of dialysis patients in Brazil. At least 10% of them do not respond adequately to clinical treatment, requiring surgical correction. At the moment, two surgical techniques are effective in controlling SHPT in critically ill patients: subtotal parathyroidectomy and total parathyroidectomy with immediate autograft.There is wide discussion about the occurrence of hypoparathyroidism, the persistence and recurrence after each of these modalities of operation. After the procedure, in many cases, there is a need for continuous drug treatment in order to regulate circulating levels of parathyroid hormone and phosphate and increase patient survival. In the case of hypoparathyroidism, calcium and/or calcitriol replacement is required. Persistence and recurrence may require a new operation or the use of calcimimetics or vitamin D analogs to inhibit hyperfunctional parathyroid tissue.The present study aims to identify which of the mentioned surgical techniques performs better in reversing SHPT, but taking into account the estimated costs of these treatments regarding the clinical management after surgery.The project is based on a randomized clinical trial started in 2012 at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, with patients undergoing one of the surgical procedures and followed for years afterward. Data will be collected retrospectively regarding the use of medications after surgery, with an estimate of the total costs involved in different clinical situations resulting from each procedure performed.