title: Recombinant human erythropoietin usage in a large academic medical center.
abstract: OBJECTIVE
  Recombinant human erythropoeitin (rhEPO) is a highly effective but expensive drug used for the treatment of certain anemias. We considered opportunities to curtail inpatient rhEPO utilization in light of therapeutic alternatives, the drug's delayed onset of action, and the available literature.
  
  
  METHODS
  A retrospective review of rhEPO administration in a large academic medical center between February and June 2000 was conducted by using administrative databases.
  
  
  METHODS
  The computerized inpatient pharmacy transaction file of the Hospital of the University of Pennsylvania was queried to determine trends for rhEPO administration. We then employed CaduCIS (CareScience, Philadelphia, PA) to determine the clinical diagnoses and resources used for each inpatient receiving rhEPO.
  
  
  RESULTS
  In the study period, 248 inpatients received at least 1 rhEPO dose. More than 100 different physicians, representing 20 departments and divisions, ordered approximately 17 million units of rhEPO. Hematology/Oncology accounted for 33% of all units ordered, and Surgery and General Medicine ordered 16% and 14%, respectively. The usual length of stay for patients receiving rhEPO varied considerably: 34% of patients remained in hospital for < or = 7 days, while 31% remained > or = 3 weeks. As many as 34% of patients began rhEPO therapy as inpatients. Of inpatients receiving rhEPO, only 49% met labeled indications for rhEPO administration.
  
  
  CONCLUSIONS
  At our institution, approximately one half of all inpatient rhEPO usage is for an off-label indication. Utilization patterns may suggest strategies for conserving this scarce resource.
authors.affiliation: Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Bilenker
authors.forename: Richard
authors.initials: R
authors.lastname: Demers
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
authors.forename: Alan G
authors.initials: AG
authors.lastname: Wasserstein
authors.forename: Erika
authors.initials: E
authors.lastname: Peters
authors.forename: Scott
authors.initials: S
authors.lastname: Manaker
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D016527:Drug Costs / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D004921:Erythropoietin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000592:standards; D015143:Philadelphia; D011787:Quality of Health Care; D011994:Recombinant Proteins; D012189:Retrospective Studies
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin