Abstract: 【Abstract】Objective To observe the efficacy and cost- effectiveness of secondary hyperparathyroidism treated with parathyroidectomy (PTx) or drugs for one year. Methods Patients with secondary hyperparathyroidism who underwent PTx and those with similar baseline who underwent drug therapy in Yuxi People's Hospital from January 2017 to December 2020 were retrospectively reviewed. Blood biochemical values, improvement of clinical symptoms, total medical expenses, cost-effectiveness analysis, scores of the quality of life, and treatment satisfaction were collected in PTx patients and drug treatment patients after the treatments for one year. Results A total of 24 secondary hyperparathyroidism patients were eligible for the analyses. ①Serum iPTH and alkaline phosphatase levels decreased more in the PTX group than in the drug therapy group after the treatment for 3, 6 and 12 months (for iPTH: t=4.046, 2.218 and 2.934 respectively, P=0.001, 0.038 and 0.008 respectively; for alkaline phosphatase: t=- 0.437, 0.962 and 2.536 respectively, P=0.666, 0.348 and 0.026 respectively); the effective iPTH decrease rate was higher in the PTx group than in the drug therapy group (P=0.037). ② The compliant rates of serum calcium and phosphorus had no significant differences between the two groups after the treatments for 3, 6 and 12 months (for serum calcium: P=0.684, 0.214
and 0.155 respectively; for serum phosphorus: P=0.667, 0.680 and 0.680 respectively). ③The improvement rate of bone pain was higher in the PTX group than in the drug therapy group (P=0.030). ④The total medical expenses in the follow-up period of one year were similar in the two groups (3.523±1.138 vs. 4.303±1.088 × 103 yuan, t=-1.723, P=0.099). The cost-effectiveness ratio was 6.04 in the drug therapy group, and was 4.30 in the PTx group, indicating the superiority of PTx to drug therapy. The incremental cost- effectiveness ratio showed that every secondary hyperparathyroidism patient effectively treated by PTX required an additional cost of 18,700 yuan as compared with the expenses of drug treated patients. ⑤The scores of treatment satisfaction,
general health status, energy, and body pain were better in the PTX group than in the drug therapy group (t=-4.834, -2.275, -2.169 and -3.555 respectively; P<0.001, 0.033, 0.041 and 0.004 respectively). Conclusion PTx can effectively reduce the levels of iPTH and alkaline phosphatase and relieve bone pain, and is superior to drug therapy in terms of treatment satisfaction and quality of life. There was no significant difference in treatment cost between the two groups within one year, but surgical treatment was more cost-effective. For patients with higher iPTH, PTx may be superior to drug therapy.

Key words: Secondary hyperparathyroidism, Chronic kidney disease, Parathyroidectomy, Drug therapy