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Abstract: FR-PO535

Change in Payment Method and the Use of Etelcalcetide and PTH Values Among Dialysis Patients in Two Dialysis Organizations

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Moore, Carol, Amgen, Thousand Oaks, California, United States
  • Saleem, Najma, Amgen, Thousand Oaks, California, United States
  • Ma, Junjie, Amgen, Thousand Oaks, California, United States
  • Mak, Gina C., IQVIA Inc, Durham, North Carolina, United States
  • Martin, Kevin J., Saint Louis University, Saint Louis, Missouri, United States
  • Sprague, Stuart M., NorthShore University HealthSystem, Evanston, Illinois, United States
Background

The CMS has provided reimbursement for the treatment of end-stage renal disease (ESRD) under a Medicare bundled prospective payment system (PPS) since 2011. A new payment adjustment system, Transitional Drug Add-On Payment Adjustment (TDAPA), was established in 2016 to account for new therapies. Calcimimetics became eligible for TDAPA in 2018. On January 1st 2021 calcimimetics were no longer reimbursed using TDAPA. Instead, the bundle base rate was increased for all patients to support utilization of etelcalcetide based on a national average usage of 6.3% of dialysis treatments. This study described the use of etelcalcetide and the parathyroid hormone (PTH) values before and after January 1st 2021.

Methods

This was a repeated cross-sectional study. Data were collected from electronic medical records of two dialysis organizations between January 2019 and December 2021. All etelcalcetide users who visited dialysis facilities operated by the dialysis organizations were included. The number and percent of etelcalcetide continuers and the average PTH values of all patients by month were reported. Additionally, we identified those whose last dose of etelcalcetide was between December 1st 2020 and January 31st 2021 and reported PTH values among those in the 9 months prior and after the month of last dose.

Results

The mean of monthly average number of patients was 34,924 during the study period. The mean of monthly average number of etelcalcetide continuers was 5,105 (14.2%) between January 2019 and December 2020 and dropped to 217 (0.7%) in 2021 after the ESRD PPS policy change. The mean of monthly average PTH values between January 2019 and December 2020 was 483 pg/ml (range, 436 pg/ml to 533 pg/ml), while it increased to 544 pg/ml (range, 485 pg/ml to 601 pg/ml) in 2021. We identified 3,560 etelcalcetide discontinuers whose last dose was between December 1st 2020 and January 31st 2021. The mean of monthly average PTH values in the 9 months prior to the last dose was 579 pg/ml, while it was 745 pg/ml in the 9 months after the last dose.

Conclusion

A major decrease in etelcalcetide use and an increase in average PTH values were observed after the implementation of changes in the ESRD PPS. Future studies are warranted to investigate the impact of the policy change on patient outcomes.

Funding

  • Commercial Support – Amgen