Costs associated with erythropoiesis-stimulating agent administration to hemodialysis patients.
BACKGROUND
Treatment of anemia in hemodialysis patients usually requires the use of expensive erythropoietic proteins. Cost analyses usually focus on drug acquisition costs. Other costs associated with anemia therapy include resources for anemia monitoring as well as preparation and administration of an erythropoiesis-stimulating agent.


METHODS
The nonacquisition costs associated with subcutaneous administration of epoetin alfa were determined in a Canadian hemodialysis unit. A time-and-motion technique was used to determine the nursing time for preparation and administration. Fixed anemia costs were inventory control, monitoring, blood sampling, and laboratory analysis. Variable costs were those which varied with dosing frequency. The costs are expressed in Canadian dollars (2005).


RESULTS
The mean time associated with preparation and administration was 3.2 min/injection. The annual nonacquisition per patient cost was CAD 2,290.04. Fixed costs were CAD 1,946.01, while the variable costs were CAD 344.03/year. Sensitivity analysis showed a decrease in cost to CAD 1,611.34, if iron monitoring were decreased from monthly to 3 monthly, and to CAD 2,090.66, if patients were converted to less frequent dosing using darbepoetin alfa.


CONCLUSIONS
The nonacquisition costs associated with anemia therapy in hemodialysis patients are considerable. Less frequent monitoring of iron therapy and less frequent dosing could decrease costs by CAD 678.40 and CAD 199.38/patient/year, respectively.
Churchill
David N
DN
Division of Nephrology, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada. dchurchill1@cogeco.ca
Macarios
David
D
Attard
Cheryl
C
Kallich
Joel
J
Goeree
Ron
R
D000740:Anemia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D015897:Comorbidity; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D018803:Models, Economic; D009864:Ontario / Q000453:epidemiology; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000191:economics* / Q000706:statistics & numerical data
D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa