Potential cost savings of erythropoietin administration in end-stage renal disease.
BACKGROUND
In a Department of Veterans Affairs randomized controlled trial, a lower dose of recombinant human erythropoietin (epoetin) was shown to attain target hematocrit levels when administered subcutaneously compared with intravenously. Since epoetin is expensive, optimizing the therapeutic effect of epoetin using a strategy that includes subcutaneous administration could lead to substantial cost savings.


METHODS
We used an economic cost projection model to estimate potential savings to the Medicare End-Stage Renal Disease Program that could occur during a transition from intravenous to subcutaneous administration of epoetin among hemodialysis patients. Data included clinical results from the Department of Veterans Affairs randomized controlled trial, the 1998 Centers for Medicare and Medicaid Services' End-Stage Renal Disease Core Indicators Survey, and the 1997-1998 Medicare claims files. In sensitivity analyses, we varied the expected dose reductions (10% to 50%) and the proportion of patients (25% to 100%) who switched to subcutaneous administration.


RESULTS
Medicare cost savings were estimated at $47 to $142 million annually as 25% to 75% of hemodialysis patients who received epoetin intravenously switched to subcutaneous administration while reducing the dose by 32%. A minimal reduction (10%) in epoetin dose would result in Medicare cost savings of an estimated $15 to $44 million annually.


CONCLUSIONS
Administering epoetin subcutaneously would provide substantial cost savings to Medicare. For the transition to occur, consensus among stakeholders is needed, especially among patients whose treatment satisfaction and health-related quality of life would be most affected.
Hynes
Denise M
DM
Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Hines, Edward G Hines, JR VA Hospital, Illinois 60141, USA.
Stroupe
Kevin T
KT
Greer
Joel W
JW
Reda
Domenic J
DJ
Frankenfield
Diane L
DL
Kaufman
James S
JS
Henderson
William G
WG
Owen
William F
WF
Rocco
Michael V
MV
Wish
Jay B
JB
Kang
Jeffery
J
Feussner
John R
JR
D003365:Costs and Cost Analysis; D004921:Erythropoietin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006400:Hematocrit; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D014481:United States
D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin