Kidney Week

Abstract: SA-PO666

Variability and Facility Predictors of Cinacalcet Prescription Among US Hemodialysis Facilities

Session Information

• Bone and Mineral Metabolism: Clinical - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Fuller, Douglas S., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Douglas S. Fuller,

• Xing, Shan, Amgen Inc, Thousand Oaks, California, United States

Shan Xing,

• Belozeroff, Vasily, Amgen Inc, Thousand Oaks, California, United States

Vasily Belozeroff,

• Yehoshua, Alon, Amgen Inc, Thousand Oaks, California, United States

Alon Yehoshua,

• Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States

Hal Morgenstern,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Rubin, Robert J., Georgetown University, Bethesda, Maryland, United States

Robert J. Rubin,

• Bhatt, Nisha, Amgen Inc, Thousand Oaks, California, United States

Nisha Bhatt,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

Background

Calcimimetic drugs used to treat secondary hyperparathyroidism (SHPT) are being considered for inclusion in the ESRD bundled payment system. Understanding of utilization patterns of calcimimetics across dialysis facilities may help align financial incentives with clinical goals. The objective of our study was to describe the distribution of cinacalcet prescription across dialysis facilities and to explore factors that may influence utilization of cinacalcet.

Methods

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 US hemodialysis facilities (10,521 patients). Based on associations with PTH levels from patient-level analyses, we used linear mixed-effects regression to estimate the association between three facility-level exposures – % black, % <65 years old, % having a dialysis vintage ≥3 years – and the prevalence of cinacalcet prescription, adjusting for facility- and patient-level potential confounders.

Results

The average unadjusted mean percentage of patients in each facility prescribed cinacalcet was 23.0% in June 2014 (median, 21.9%; IQR, 12.8-30.5%). The percentage of patients in each facility prescribed cinacalcet in June 2014 was strongly and positively associated with the percentage of patients in the facility who were black, <65 years old, and had a dialysis vintage ≥3 years, adjusting for patient case-mix and dialysis chain affiliation (Figure).

Conclusion

Given these systematic differences of cinacalcet use across dialysis facilities, facilities treating proportionally more patients who are black, under age 65, and having ≥3 years on dialysis may bear disproportionally greater financial burden for treating patients with SHPT after calcimimetics are added to the ESRD bundle. Additional studies evaluating the differential financial impact on facilities of adding calcimimetics to the bundle are warranted.

Funding

• Commercial Support – All support is provided without restrictions on publications. All funds are made to Arbor Research Collaborative for Health and not directly to Mr. Fuller. The full DOPPS Program support and additional support for specific projects and countries can be found here: https://www.dopps.org/AboutUs/Support.aspx