Erythropoiesis-stimulating agents in anaemia due to chronic kidney disease: a cost-minimization analysis
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Background Some publications have shown that equivalent doses of erythropoiesis-stimulating agents (ESA) defined on label differ from those effective in clinical practice. Therefore, real costs could vary from theoretical costs in the treatment of anaemia in chronic kidney disease (CKD). Objectives To perform a cost-minimization analysis to establish the economic impact of the principal ESAs used in treating anaemia secondary to CKD in daily practice. Secondary objectives: to determine patient-month cost based on the erythropoietin resistance index (ERI); to analyze the difference in cost between pre-dialysis and peritoneal dialysis (PD) patients; and to analyze the association between iron deposits and ESA cost. Setting This study was carried out at 2 tertiary hospitals in Spain. Method A multicentre cost-minimization analysis was performed in adult outpatients treated with ESAs for anaemia due to CKD. Main outcome measure The primary outcome was the patient-month cost for each ESA. Results 409 patients were included. Median patient-month cost was: epoetin (103.2 [63.7, 187.8] euros), darbepoetin α (134.4 [67.2, 216.0] euros) and CERA (147.5 [98.3, 196.7] euros). Median patient-month cost according to ERI was: epoetin (1.60 [0.90, 2.60] euros/kg), darbepoetin α (2.01 [0.95, 3.48] euros/kg) and CERA (1.87 [1.33, 3.00] euros/kg). Median patient-month cost in pre-dialysis was 126.0 (73.7, 201.6) euros and in PD 153.0 (100.2, 275.4) euros. Median patient-month cost for patients with TSI < 20 % was 147.5 (98.3, 224.9) euros compared to 100.9 (67.2, 196.7) euros which was the cost for patients with IST ≥ 20 %. The median patient-month cost for patients with ferritin < 100 mcg/l was 134.4 (85.0, 201.6) euros compared to 100.8 (68.8, 196.7) euros, which was the cost for patients with ferritin ≥ 100 mcg/l (p = 0.242). Conclusion Doses of CERA used in clinical practice are lower than those recommended on label, which directly influences cost and treatment efficiency. Cost stratification based on iron deposits has shown that patients with low TSI or ferritin require higher doses and consequently an associated higher cost. Thus, to guarantee adequate iron levels is essential in the rational use of ESAs.
KeywordsAnaemia Chronic kidney disease Cost Efficiency Erythropoiesis-stimulating agents Spain
The authors would like to thank the patients, investigators and study personnel who made the study possible. The authors would also like to thank Samantha Wilkinson for editorial assistance.
This study has been carried out within an investigation project financed by the Spanish Ministry of Health (Orden SAS/2377/2010, BOE [11th September 2011]).
Conflicts of interest
The authors declare no conflict of interests.
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