title: [Direct medical cost of erythropoiesis-stimulating agents in anaemia treatment of chronic renal failure patient: a literature review].
abstract: BACKGROUND
  Management of anaemia in chronic renal insufficiency (CRI) represents an important medico-economic challenge because of the great number of patients and the cost of the erythropoiesis-stimulating agent (ESA). The aim of this study was to identify determinants of the costs associated with these treatments in order to choose, with equal efficacy, the most efficient ASE.
  
  
  METHODS
  A bibliographic research was realised by Medline database interrogation.
  
  
  RESULTS
  Among the direct medical costs, five studies showed that acquisition of epoetine alfa (EA) compared to darbepoetin alfa (DA) was less expensive. Concerning the costs associated with the route of administration, the subcutaneous injection (SC) of epoetine allowed a gain in costs because of the decrease of doses compared to the intravenous (IV) route. The switch from EA in SC to DA in IV, for hemodialysis patients, was associated with a reduction of the number of injections and with a treatment's cost lower by DA than by EA. Costs related to the regimen of administration, notably those related to nursing, medical and pharmaceutical time, were negligible towards those associated to the acquisition of the ASE. Finally, the costs of the therapeutic follow-up and treatment of the adverse effects of the ASE were similar between the EA and the DA.
  
  
  CONCLUSIONS
  The costs associated with the prices of acquisition of the ASE, negotiated by the structure of care, represent the most important part of the direct medical costs.
authors.affiliation: Unité de recherche clinique, hospices civils de Lyon, pôle information médicale évaluation recherche, 69003 Lyon, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Ranchon
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Hédoux
authors.forename: Maurice
authors.initials: M
authors.lastname: Laville
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.forename: Evelyne
authors.initials: E
authors.lastname: Decullier
authors.forename: François
authors.initials: F
authors.lastname: Chapuis
authors.forename: Laure
authors.initials: L
authors.lastname: Huot
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000191:economics* / Q000209:etiology; D000068256:Darbepoetin alfa; D004180:Direct Service Costs; D016527:Drug Costs; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics*; D005602:France; D017048:Health Care Costs; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000150:complications*; D011994:Recombinant Proteins
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa