Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin.
In April 2006, Japan's health insurance system instituted a bundling policy that included recombinant human erythropoietin (rHuEPO) in outpatient hemodialysis therapy. To evaluate outcomes of this, we analyzed a prospective cohort of hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study, in 53 facilities using prevalent cross-sections of 1584 patients before and 1622 patients after the rHuEPO reimbursement change. Patient data included hemoglobin levels, iron management profiles, and anemia treatment with rHuEPO and intravenous iron. No significant differences were found in pre- or post-policy cross-sections for hemoglobin distributions or the percentage of patients prescribed rHuEPO. Among patients receiving rHuEPO, the mean dose significantly decreased by 11.8 percent. The percentage of patients prescribed intravenous iron over 4 months significantly increased; however, the mean dose of iron did not significantly change. Thus, this bundling policy was associated with reduced rHuEPO doses, increased intravenous iron use, and stable hemoglobin levels in Japanese patients receiving hemodialysis.
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. tahasegawa-npr@umin.net
Takeshi
T
Hasegawa
Jennifer L
JL
Bragg-Gresham
Ronald L
RL
Pisoni
Bruce M
BM
Robinson
Shunichi
S
Fukuhara
Takashi
T
Akiba
Akira
A
Saito
Kiyoshi
K
Kurokawa
Tadao
T
Akizawa
D000368:Aged; D000553:Ambulatory Care / Q000331:legislation & jurisprudence; D000740:Anemia / Q000097:blood / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D016527:Drug Costs; D004363:Drug Utilization / Q000331:legislation & jurisprudence; D004921:Erythropoietin / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D005102:Health Expenditures / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000191:economics; D006397:Hematinics / Q000008:administration & dosage* / Q000191:economics; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence; D007501:Iron / Q000008:administration & dosage; D007564:Japan; D007676:Kidney Failure, Chronic / Q000097:blood / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000331:legislation & jurisprudence*; D011446:Prospective Studies; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron