[Chronic kidney disease (CKD) and bone. Control of CKD-MBD from the viewpoint of the medical cost].

Pharmacoeconomics (PE) , which contribute to the decisions on the population rather than the patient level such as policy making, provides us with the cost and value of a given drug. In the midst of terrible economic climate, medications for CKD-MBD are reviewed from the viewpoint of PE in this manuscript. DCOR trial is the only study in maintenance hemodialysis patients with mortality as a primary endpoint, which compared expensive sevelamer hydrochloride and economical calcium containing phosphate binders, showing no difference in mortality between these drugs. This means that calcium containing phosphate binders are more cost-effective. Cost utility analysis from the United States revealed that parathyroidectomy became more cost-effective at 16 months than cinacalcet hydrochloride, which theoretically have to be continued throughout life. The effect of active vitamin D on mortality is controversial, since there has not been any prospective randomized controlled trial. Taking these findings into account, cinacalcet should be indicated only in those patients who have secondary hyperparathyroidism refractory to conventional therapy and for whom parathyroidectomy is not a good indication. Furthermore, when cinacalcet have to be used, we should give priority to calcium containing phosphate binders rather than expensive sevelamer from the viewpoint of the medical cost. Moreover, the doses of cinacalcet should be minimized by administering inexpensive vitamin D concomitantly.