title: Costs of managing anemia with erythropoiesis-stimulating agents during hemodialysis: a time and motion study.
abstract: Use of erythropoiesis-stimulating agents (ESAs) presents a significant time and cost burden in the management of anemia of chronic kidney disease (CKD). We conducted a prospective, observational, activity-based costing study to estimate the health care personnel time and resulting direct medical costs associated with administering epoetin 3 times weekly to patients with end-stage renal disease on dialysis. The study was conducted at 5 US hemodialysis centers. The personnel time and costs were derived from time and motion observations. Predicted time and cost savings were modeled for switching patients to once-monthly ESA therapy. Patients also completed a survey questionnaire to assess their level of CKD knowledge and information needs. Total per-patient-per-year (PPPY) time expended on anemia management with epoetin averaged 608 minutes (range 512-915 minutes), with an average PPPY cost of $548 (range $342-$651). Use of a once-monthly ESA, compared with epoetin, could decrease average PPPY time expenditure by 79% (127 minutes [range 96-173 minutes]) and reduce PPPY costs by 81% ($104 [range $79-$136]). The patient questionnaire reported insufficient education on CKD. Use of a once-monthly ESA to correct anemia in dialysis patients may provide substantial time, resource, and cost savings compared with current treatment practices.
authors.affiliation: Satellite Healthcare Inc., Mountain View, California, USA. schillerb@satellitehealth.com
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schiller
authors.forename: Sheila
authors.initials: S
authors.lastname: Doss
authors.forename: Erwin
authors.initials: E
authors.lastname: DE Cock
authors.forename: Michael A
authors.initials: MA
authors.lastname: Del Aguila
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D017046:Cost Savings; D003625:Data Collection; D016527:Drug Costs; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006397:Hematinics / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000191:economics*; D013996:Time and Motion Studies
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin