[Basic and clinical aspects of calcimimetics. Calcimimetics from the viewpoint of medical cost]

Cinacalcet hydrochrolide has now become available in Japan after a three-year interval from its introduction to Western countries. The clinical use of this drug should certainly bring benefit to the treatment of secondary hyperparathyroidism among dialysis patients. But, at the same time, it should increase the medical cost, as shown in the cost utility analyses reported previously in Western countries. Moreover, the longevity of Japanese hemodialysis patients might increase the difference between the cost of parathyroidectomy (PTX) and that of cinacalcet treatment which theoretically should be continued throughout their life. From the viewpoint of the cost, the intervention techniques, such as PTX and percutaneous ethanol injection therapy, should be encouraged. When sevelamer hydrochloride was first introduced in Japan, the abrupt and complete transition from calcium containing phosphate binder to large amount of sevelamer brought about severe constipation among Japanese dialysis patients, resulting in unwillingness or reluctance to take this agent and low compliance. Looking back on this bitter experience and again from the viewpoint of the cost, it is reasonable in Japan to administer small dose of cinacalcet with concomitant vitamin D therapy.