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International Journal of Clinical Pharmacy

, Volume 35, Issue 3, pp 463–468 | Cite as

Erythropoiesis-stimulating agents in anaemia due to chronic kidney disease: a cost-minimization analysis

  • Vicente Escudero-VilaplanaEmail author
  • Concepción Martínez-Nieto
  • Juan Manuel López-Gómez
  • Almudena Vega-Martínez
  • José María Bellón-Cano
  • María Sanjurjo-Sáez
Research Article

Abstract

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.

Keywords

Anaemia Chronic kidney disease Cost Efficiency Erythropoiesis-stimulating agents Spain 

Notes

Acknowledgements

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.

Funding

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.

References

  1. 1.
    Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health. 2008;8:117.PubMedCrossRefGoogle Scholar
  2. 2.
    Otero A, Gayoso P, García F, De Francisco AL. Epidemiology of chronic renal disease in the Galician population: results of the pilot Spanish EPIRCE study. Kidney Int. 2005;68:S16–9.CrossRefGoogle Scholar
  3. 3.
    Marín R, Goicoechea MA, Gorostidi M, Cases A, Díez J, Escolar G, et al. Guidelines of the Spanish Society of Nephrology: the kidney and cardiovascular disease Short version. Nefrología. 2006;26:31–44.PubMedGoogle Scholar
  4. 4.
    Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anaemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162(12):1401–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Winearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM. Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet. 1986;2(8517):1175–8.PubMedCrossRefGoogle Scholar
  6. 6.
    European Public Assessment Reports: Mircera [document on the internet]. London: European Medicines Agency; 2007 [access in January 2013]. Available from: http://www.ema.europa.eu/docs/es_ES/document_library/EPAR_-_Product_Information/human/000739/WC500033672.pdf.
  7. 7.
    Alcázar Arroyo R, Orte L, González Parra E, Górriz JL, Navarro JF, de Martín Francisco AL. Documento de consenso SEN-semFYC sobre la enfermedad renal crónica. Nefrologia. 2008;28(3):273–82.Google Scholar
  8. 8.
    Detsky AS, Laupacis A. Relevance of cost-effectiveness analysis to clinicians and policy makers. JAMA. 2007;298(2):221–4.PubMedCrossRefGoogle Scholar
  9. 9.
    European Public Assessment Reports: Epopen, Neorecormon, Aranesp and Mircera [document on the internet]. London: European Medicines Agency; 1995 [access in January 2013]. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/landing/epar_search.jsp&mid=WC0b01ac058001d124.
  10. 10.
    Molina M, García Hernández MA, Navarro MJ, De Gracia MC, Ortuño T. Change of EPO treatment from subcutaneous epoetin to intravenous epoetin or darbepoetin alpha. Nefrologia. 2004;24(6):564–71.PubMedGoogle Scholar
  11. 11.
    Pérez-García R, Rodríguez P, Jofre R, López-Gómez JM, Villaverde MT, Blanco A, et al. Resistance index to epoetin alpha and to darbepoetin-alpha in chronic hemodialysis patients: a cohort study. Nefrologia. 2007;27(3):340–9.PubMedGoogle Scholar
  12. 12.
    Molina M, Navarro MJ, De Gracia C, Álvarez G, De Alarcón R, García MA. Change in darbepoetin alfa administration schedule affects erythropoiesis-stimulating agent resistance in patients with chronic kidney disease receiving hemodialysis. Ren Fail. 2008;30:778–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Minutolo R, Zamboli P, Chiodini P, Mascia S, Vitiello S, Stanzione G, et al. Conversion of darbepoetin to low doses of CERA maintains hemoglobin levels in non-dialysis chronic kidney disease patients. Blood Purif. 2010;30(3):186–94.PubMedCrossRefGoogle Scholar
  14. 14.
    Levey AS, Greene T, Kusek JW, Beck GJ. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11:155A.Google Scholar
  15. 15.
    Resolución de 28 de diciembre de 2011, de la Dirección General de Farmacia y Productos Sanitarios, por la que se determinan los nuevos conjuntos de medicamentos de ámbito hospitalario y sus precios de referencia. [document on the internet]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2011 [access in January 2013]. Available from: http://www.boe.es/boe/dias/2011/12/30/pdfs/BOE-A-2011-20545.pdf.
  16. 16.
    Public Statement. Epoetins and the risk of tumour growth progression and thromboembolic events in cancer patients and cardiovascular risks in patients with chronic kidney disease. Doc Ref. EMEA/496188/2007 [document on the internet]. London: European Medicines Agency; 2007 [access in January 2013]. Available from: http://www.emea.europa.eu/docs/en_GB/document_library/Public_statement/2009/11/WC500015604.pdf.
  17. 17.
    Alfaro Cuenca A, Gallego Jordán B, Martín Piñero M. Estudio coste-eficacia de dos estimulantes eritropoyéticos para el tratamiento de la anemia en pacientes con insuficiencia renal crónica en hemodiálisis: epetinum alfa y darbepoetina alfa. Rev Soc Esp Enferm Nefrol. 2004;7(3):191–4.CrossRefGoogle Scholar
  18. 18.
    Crespo Palomo C, Brosa Riestra M, Arocho R. Budget impact analysis of darbepoetin-alfa (aranesp) in the treatment of anemia associated with chronic kidney disease in Spain. Rev Esp Econ Salud. 2008;7(5):197–204.Google Scholar
  19. 19.
    Sanz-Granda A. Probabilistic cost-minimisation analysis of darbepoetin alpha versus epoetin alpha in treating anaemia secondary to chronic renal failure. Assessment in Spanish clinical practice. Farm Hosp. 2009;33(4):208–16.PubMedCrossRefGoogle Scholar
  20. 20.
    Morreale A, Plowman B, DeLattre M, Boggie D, Schaefer M. Clinical and economic comparison of epoetin alfa and darbepoetin alfa. Curr Med Res Opin. 2004;20(3):381–95.PubMedCrossRefGoogle Scholar
  21. 21.
    Hörl WH, Jacobs C, Macdougall IC, Valderrábano F, Parrondo I, Thompson K, et al. European best practice guidelines 14–16: inadequate response to epoetin. Nephrol Dial Transplant. 2000;15(4):43–50.PubMedGoogle Scholar
  22. 22.
    Hsu CY, Mcculloch CE, Curhan GC. Iron status and hemoglobin level in chronic renal insufficiency. J Am Soc Nephrol. 2002;13(11):2783–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Vicente Escudero-Vilaplana
    • 1
    Email author
  • Concepción Martínez-Nieto
    • 2
  • Juan Manuel López-Gómez
    • 3
    • 4
  • Almudena Vega-Martínez
    • 3
    • 4
  • José María Bellón-Cano
    • 4
  • María Sanjurjo-Sáez
    • 1
    • 4
  1. 1.Pharmacy Service, Gregorio Marañón University General HospitalMadridSpain
  2. 2.Pharmacy Service, La Princesa University HospitalMadridSpain
  3. 3.Nephrology Service, Gregorio Marañón University General HospitalMadridSpain
  4. 4.Institute for Health Research Gregorio MarañónMadridSpain

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