Cost should be the principal determinant of choice of erythropoiesis-stimulating agent in chronic haemodialysis patients.
OBJECTIVE
Erythropoiesis-stimulating agents (ESAs) are effective in the management of the anaemia of chronic kidney disease but add substantially to the treatment costs. We performed a comparison cross-sectional analysis of ESA prescribing in 4 dialysis centres in Northern Ireland.


METHODS
The ESA prescription and current haemoglobin (Hb) concentration for all patients on haemodialysis (HD) treatment for at least 3 months was extracted from the renal data system.


RESULTS
A total of 403 patients were analysed, 184 (46%) were prescribed epoetin beta and 219 (54%) darbepoetin alpha. The mean Hb concentrations for both agents were comparable overall (Hb = 11.4 and 11.7 g/dl, p = 0.13), and for subcutaneous (SC) and intravenous (IV) administration: epoetin beta 11.5 g/dl (n = 119) and 11.4 g/dl (n = 65) (p = 0.70), and darbepoetin alpha 11.8 g/dl (n = 39) and 11.6 g/dl (n = 180) (p = 0.49). The mean weekly dose was 7,941 units of epoetin beta with SC and 9,200 units with IV administration (p = 0.10), and 45 mug SC and 46 mug IV of darbepoetin alpha (p = 0.94). The weekly cost of achieving equivalent Hb levels was GBP 61.86 (EUR 90.57/USD 115.68) with SC and GBP 71.67 (EUR 104.93/USD 134.02) with IV epoetin beta, and GBP 70.78 (EUR 103.63/USD 132.36) with SC and GBP 72.18 (EUR 105.68/USD 134.98) with IV darbepoetin alpha.


CONCLUSIONS
Epoetin beta and darbepoetin alpha are equally effective ESAs and the choice of ESA prescribed in stable HD patients should be determined by cost.
Regional Nephrology Unit, Belfast City Hospital, Belfast, Ireland. aecourtney@doctors.org.uk
Aisling E
AE
Courtney
Peter T
PT
McNamee
A Peter
AP
Maxwell
D000740:Anemia / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D002755:Choice Behavior; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D000068256:Darbepoetin alfa; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics*
D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa