title: Drug utilization and cost for erythropoiesis-stimulating agents in a long-term care resident population with chronic kidney disease.
abstract: OBJECTIVE
  To compare drug-utilization patterns and costs in patients with chronic kidney disease (CKD), not on dialysis, yet receiving epoetin alfa (EPO) or darbepoetin alfa (DARB) in a long-term care setting.
  
  
  METHODS
  A retrospective analysis of pharmacy dispensing from January 2007 through March 2009, was conducted using the AnalytiCareSM LTC database.
  
  
  METHODS
  Long-term care.
  
  
  METHODS
  Patients>or=18 years of age, with >or=1 EPO or DARB dose dispensed, were included. Patients dispensed both agents, diagnosed with cancer, receiving chemotherapy, radiation therapy, or renal dialysis, were excluded.
  
  
  METHODS
  Mean cumulative erythropoiesis-stimulating agent (ESA) dose was used to calculate drug cost (using April 2009 wholesale acquisition cost) and dose ratio (Units EPO:mcg DARB). Results were also stratified by payer types.
  
  
  RESULTS
  A total of 2,259 patients were identified (EPO 1,640; DARB 619). EPO patients were slightly older (76.1 vs. 74.8 years of age, P=0.021), with similar proportion of women, compared with DARB patients. Mean (SD) cumulative dose was 98,420 (122,381) Units for EPO and 360 (428) mcg for DARB, resulting in a dose ratio of 273:1 (Units EPO:mcg DARB). The corresponding drug cost was 42% higher with DARB than with EPO ($1,734 vs. $1,217, P<0.001). Stratified analysis by payer types yielded similar results (dose ratios: 299:1 and 270:1 [Units EPO:mcg DARB]); cost premiums: 30% and 44% for Medicare Part A/Facility and Medicare Part D/Medicaid groups, respectively.
  
  
  CONCLUSIONS
  This study of long-term care CKD patients receiving ESAs reported 42% higher drug cost with DARB compared with EPO and a dose ratio of 273:1.
authors.affiliation: Groupe d'analyse, Ltée, Montréal, Québec, Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Lafeuille
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bailey
authors.forename: Francis
authors.initials: F
authors.lastname: Vekeman
authors.forename: Brett S
authors.initials: BS
authors.lastname: Kilpatrick
authors.forename: Mekré
authors.initials: M
authors.lastname: Senbetta
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Piech
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy*; D002908:Chronic Disease; D015331:Cohort Studies; D016527:Drug Costs; D004363:Drug Utilization; D005260:Female; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008134:Long-Term Care; D008297:Male; D012189:Retrospective Studies
chemical_list: D006397:Hematinics