title: Utilization and cost comparison of erythropoiesis-stimulating agents in inpatient and outpatient hospital settings.
abstract: OBJECTIVE
  To compare utilization and associated costs of epoetin alfa (EPO) and darbepoetin alfa (DARB), two erythropoiesis-stimulating agents (ESAs), in patients with cancer undergoing chemotherapy and patients with chronic kidney disease (CKD) not on dialysis in inpatient and outpatient hospital settings.
  
  
  METHODS
  An analysis of medical claims recorded between January 2006 and December 2009 was conducted using the Premier Perspective Comparative Hospital database. Patients included were ≥18 years old with cancer and chemotherapy or with pre-dialysis CKD and with ≥1 claim for EPO or DARB during a hospital inpatient or outpatient treatment episode. Patients treated with both ESAs or who were receiving dialysis were excluded. Mean cumulative drug costs and dose ratios (units EPO: mcg DARB) were calculated using cumulative dose and April 2010 wholesale acquisition costs.
  
  
  RESULTS
  Cancer chemotherapy: 13,832 inpatient stays (EPO: 10,454; DARB: 3378) and 5590 outpatient treatment episodes (EPO: 2856; DARB: 2734) were identified. The inpatient and outpatient populations reported ESA dose ratios of 230:1 and 238:1 with DARB cost premiums of 42% (EPO: $948; DARB: $1348) and 38% (EPO: $3358; DARB: $4627), respectively. CKD: 148,746 hospital stays (EPO: 116,017; DARB: 32,729) and 11,012 outpatient treatment episodes (EPO: 6921; DARB 4091) were identified. The inpatient and outpatient populations reported ESA dose ratios of 251:1 and 257:1 with DARB cost premiums of 30% (EPO: $566; DARB: $738) and 27% (EPO: $2077; DARB: $2642), respectively.
  
  
  CONCLUSIONS
  The lack of randomization may have led to confounding by indication. In addition, statistical significance must be interpreted with caution in studies involving large samples.
  
  
  CONCLUSIONS
  This study of 19,422 patients with cancer receiving chemotherapy and 159,758 patients with pre-dialysis CKD reported ESA dose ratios ranging from 230:1-257:1 (units EPO: mcg DARB) and associated cost premiums of 27-42% for DARB.
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: R
authors.initials: R
authors.lastname: Scott McKenzie
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis / Q000379:methods; D000068256:Darbepoetin alfa; D016208:Databases, Factual; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa