Meta-analysis of subcutaneous versus intravenous epoetin in maintenance treatment of anemia in hemodialysis patients.
BACKGROUND
Clinical and pharmacokinetic studies have shown that target hemoglobin or hematocrit levels can be maintained using a reduced recombinant human erythropoietin (epoetin) dosage by switching from intravenous (IV) to subcutaneous (SC) administration.


METHODS
We conducted a meta-analysis of comparative studies of epoetin administered IV versus SC to assess the relative costs of these administration routes. Twenty-seven prospective clinical studies involving 916 patients were included in the analysis. The average difference between IV and SC doses of epoetin and average difference in drug costs between administration routes were determined.


RESULTS
The average reduction in dose in patients treated with SC versus IV epoetin was 48 IU/kg/wk (P < 0.001), representing an average annual cost savings with SC administration of US $1,761 +/- $1,080 (SD) per patient. The difference between SC and IV doses was similar in both parallel- and crossover-design studies. A retrospective US survey showed a dose reduction of 26 IU/kg/wk (P < 0.001) with SC administration, translating to an annual savings of $946 per patient.


CONCLUSIONS
This study indicates that the cost of epoetin is reduced substantially when administered SC in comparison to IV. Recommendations of current US and European guidelines, which encourage the use of SC administration, not only have a sound rationale in terms of efficacy and safety, but also have a sound economic basis.
Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA.
Anatole
A
Besarab
Carolina M
CM
Reyes
John
J
Hornberger
D000740:Anemia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005060:Europe; D006287:Health Planning Guidelines; D006801:Humans; D007275:Injections, Intravenous / Q000191:economics; D007279:Injections, Subcutaneous / Q000191:economics; D011446:Prospective Studies; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics; D012189:Retrospective Studies; D014481:United States
D011994:Recombinant Proteins; D004921:Erythropoietin