Summary
Introduction
During the maintenance dialysis as well the pre-dialysis period anemia represents one of the most frequent and debilitating diseases associated with chronic kidney disease (CKD). If anemia is untreated, the quality of life is reduced and survival is shortened. Epoetin and darbepoetin alfa are Erythropoietin Receptor Agonists (ERAs) indicated for the treatment of anemia in patients with CKD.
Materials and methods
Data for this retrospective study were derived from the administrative database of a middle-sized (half a million beneficiaries) Local Health Unit in Northern Italy. A sample was built by selecting all patients who, between 2005 and 2006, had a diagnosis of CKD and had received at least two prescriptions for ERAs. The study evaluated the durations of treatments, the RDDs (Received Daily Doses), the DCR (Dose Conversion Ratio) between epoetin and darbepoetin alfa, and the weekly costs associated with either treatment.
Results
The original sample consisted of 415 patients (mean age: 72.9 years, 53.7% males). The mean duration of treatment was 25.29 weeks for epoetin and 22.72 weeks for darbepoetin alfa (p = 0.02). The weighted relative mean RDD was 3.72 µg for darbepoetin alfa (weekly mean dosage: 26.04 µg) and 572.57 IU for epoetin (weekly dosage mean: 4008.00 IU), with a DCR between epoetin and darbepoetin alfa of 153.94 IU: 1 µg. The weekly mean cost of treatment was € 43.40 for patients treated with epoetin and € 72.36 for patients treated with darbepoetin alfa (p < 0.001).
Discussion and conclusions
Administrative databases increasingly represent an important data source to conduct drug utilization studies. Based on data from a Local Health Unit, we performed an analysis focused on the use of ERAs in the treatment of anemia in patients with chronic kidney disease. The analysis results were interesting, particularly as attempt to estimate the DCR between epoetin and darbepoetin alfa (153.94 IU: 1 µg), which resulted consistent with other European studies. This evaluation showed that epoetin is a cost-saving strategy compared with darbepoetin alfa in the treatment of anemia in patients with chronic kidney disease. An important limitation was that patient records had not a severity of disease indicator. Probably the presence of a severity disease indicator might have helped to capture more clearly the analysis results.
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Bibliografia
Hymes J, Bickimer T, Jackson JH, et al. Dosing patterns, drug costs, and hematologic outcome in anemic patients with chronic kidney disease switching from darbepoetin alfa to epoetin alfa. Curr Med Res Opin 2007; 23: 1931–7
Colucci G, Pavone F, Calandro L, et al. Pochi malati, grandi costi L’insufficienza renale cronica. Rivista SIMG Numero 8, 2001 (http://www.simg.it/servizi/servizi_riviste2001/numero8/5.htm
Nurko S. Anemia in chronic kidney disease: Causes, diagnosis, treatment. Cleve Clin J Med 2006; 73: 289–97
Rossert J, Froissart M, Jacquot C. Anemia management and chronic renal failure progression. Kidney Int Suppl. 2005; 99: S76–S81
Dean BB, Dylan M, Gano Air, et al. Erythropoiesis stimulating protein therapy and the decline of renal function: A retrospective analysis of patients with chronic kidney disease. Curr Med Res Opin 2005; 21: 981–7
Bishop M. Sick and tired. Nurs Stand 2005; 20: 26–7
Besarab A, Aslam M. Should the hematocrit (hemoglobin) be normalized in pre-ESRD or dialysis patients?Yes! Blood Purif 2001; 19: 168–74
Fallowfield L, Gagnon D, Zagari M, et al. Multivariate regression analyses of data from a randomised, double-blind, placebocontrolled study confirm quality of life benefit of epoetin alfa in patients receiving non-platinum chemotherapy. Br J Cancer 2002; 87: 1341–53
Leitgeb C, Pecherstorfer M, Fritz E, Ludwig H. Quality of life in chronic anemia of cancer during treatment with recombinant human erythropoietin. Cancer 1994; 73: 2535–42
Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 1997; 34: 4–12
Cella D. Factors influencing quality of life in cancer patients: anemia and fatigue. Semin Oncol 1998; 25: 43–6
National Kidney Foundation. KDOQI clinical practice guideline and clinical practice recommendations for anemia in chronic kidney disease: 2007 Update of hemoglobin target. Am J Kidney Dis 2007; 50: 471–530
Singh AK, Szczech L, Tang K, et al. Correction of anemia with epoetin alfa in chronic kidney disease. New Engl J Med 2006; 355: 2085–98
Drüeke TB, Locatelli F, Clyne N, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. New Engl J Med 2006; 355: 2071–84
Cotter D, Thamer M, Narasimhan, et al. Translating epoetin research into practice: the role of government and the use of scientific evidence. Health Aff (Millwood). 2006; 25: 1249–59
Cremieux PY, Van Audenrode M, Lefebvre P. The relative dosing of epoetin alfa and darbepoetin alfa in chronic kidney disease. Curr Med Res Opin 2006; 22: 2329–36
Reichardt B. Cost comparison of epoetin alpha, epoetin beta and darbepoetin alpha for cancer patients with anaemia in the clinical practice setting. J Clin Phar Ther 2006; 31: 503–12
Egrie JC, Dwyer E, Lykos M, et al. Novel erythropoiesis stimulating protein (NESP) has a longer serum half-life and greater in vivo biological activity than recombinant human erythropoietin (rHuEPO). Blood 1997; 90: 56A
Macdougall IC, Gray SJ, Elston O, et al. Pharmacokinetics of novel erythropoiesis stimulating protein compared with epoetin alfa in dialysis patients. J Am Soc Nephrol 1999; 10: 2392–5
European best practice guidelines for the management of anaemia in patients with chronical renal failure. Nephrol Dial Transplant 1999; 14: 1–50
Aljama P, Bommer J, Canaud B, et al. Practical guidelines for the use of NESP in treating renal anaemia. Nephrol Dial Transplant 2001; 16: 22–8
Seidenfeld J, Piper M, Flamm C, et al. Epoetin treatment of anemia associated with cancer therapy: a systematic review and meta-analysis of controlled clinical trials. J Natl Cancer Inst 2001; 93: 1204–14
Rizzo JD, Lichtin AE, Woolf SH. et al. Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. Blood 2002; 100: 2303–20
Pohl G, Ludwig H. Supportive treatment for anemic cancer patients. Wien Med Wochenschr 2004; 154: 226–34
Locatelli F, Olivares J, Walzer R, et al. Novel erythopoiesis stimulating protein for treatment of anemia in chronic renal insufficiency. Kidney Int 2001; 60: 741–7
Provenzano R, Garcia-Mayol L, Suchinda P, et al. Once-weekly epoetin alfa for treating the anemia in chronic kidney disease. Clin Nephrol 2004; 60: 392–405
Stone WJ, Graber SE, Krantz SB, et al. Treatment of the anemia of predialysis patients with recombinant human erythropoietin: a randomized, placebo-controlled trial. Am J Med Sci 1988; 296: 171–9
Beusterien KM, Nissenson AR, Port FK, et al. The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients. J Am Soc Nephrol 1996; 7: 763–73
Moreno F, Sanz-Guajardo D, Lopez-Gomez JM, et al. Increasing the hematocrit has a beneficial effect on quality of life and is safe in selected hemodialysis patients. J Am Soc Nephrol 2000; 11: 335–42
http://www.asl.pavia.it/Popolazione.pdf. Ultimo accesso marzo 2008
Locatelli F, Canaud B, Giacardy F, et al. Treatment of anaemia in dialysis patients with unit dosing of darbepoetin alfa at a reduced dose frequency relative to recombinant human erythropoietin (rHuEpo). Nephrol Dial Transplant 2003; 18: 362–9
Mahajan S, Boulton H, Gokal R. A trial of subcutaneous administration of darbepoetin alfa once every other week for the treatment of anemia in peritoneal dialysis patients. J Nephrol 2004; 17: 687–92
Roger SD, Cooper B. What is the practical conversion dose when changing from epoetin alfa to darbepoetin outside of clinical trials? Nephrology 2004; 9: 223–8
Brunkhorst R, Bommer J, Braun J, et al. Darbepoetin alfa effectively maintains haemoglobin concentration at extended dose intervals relative to intravenous or subcutaneous recombinant human erythropoietin in dialysis patients. Nephrol Dial Transplant 2004; 19: 1224–30
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Ravasio, R., Cerra, C. & Fratino, P. Analisi dei consumi e dei costi degli agenti stimolanti l’eritropoiesi nel trattamento dell’anemia nei pazienti con insufficienza renale cronica. Pharmacoeconomics-Ital-Res-Articles 10, 161–169 (2008). https://doi.org/10.1007/BF03320652
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DOI: https://doi.org/10.1007/BF03320652