title: Erythropoiesis-stimulating agents in anaemia due to chronic kidney disease: a cost-minimization analysis.
abstract: BACKGROUND
  Some publications have shown that equivalent doses of erythropoiesis-stimulating agents (ESA) defined on label differ from those effective in clinical practice. Therefore, real costs could vary from theoretical costs in the treatment of anaemia in chronic kidney disease (CKD).
  
  
  OBJECTIVE
  To perform a cost-minimization analysis to establish the economic impact of the principal ESAs used in treating anaemia secondary to CKD in daily practice.
  
  
  OBJECTIVE
  to determine patient-month cost based on the erythropoietin resistance index (ERI); to analyze the difference in cost between pre-dialysis and peritoneal dialysis (PD) patients; and to analyze the association between iron deposits and ESA cost.
  
  
  METHODS
  This study was carried out at 2 tertiary hospitals in Spain.
  
  
  METHODS
  A multicentre cost-minimization analysis was performed in adult outpatients treated with ESAs for anaemia due to CKD.
  
  
  METHODS
  The primary outcome was the patient-month cost for each ESA.
  
  
  RESULTS
  409 patients were included. Median patient-month cost was: epoetin (103.2 [63.7, 187.8] euros), darbepoetin α (134.4 [67.2, 216.0] euros) and CERA (147.5 [98.3, 196.7] euros). Median patient-month cost according to ERI was: epoetin (1.60 [0.90, 2.60] euros/kg), darbepoetin α (2.01 [0.95, 3.48] euros/kg) and CERA (1.87 [1.33, 3.00] euros/kg). Median patient-month cost in pre-dialysis was 126.0 (73.7, 201.6) euros and in PD 153.0 (100.2, 275.4) euros. Median patient-month cost for patients with TSI < 20% was 147.5 (98.3, 224.9) euros compared to 100.9 (67.2, 196.7) euros which was the cost for patients with IST ≥ 20%. The median patient-month cost for patients with ferritin < 100 mcg/l was 134.4 (85.0, 201.6) euros compared to 100.8 (68.8, 196.7) euros, which was the cost for patients with ferritin ≥ 100 mcg/l (p = 0.242).
  
  
  CONCLUSIONS
  Doses of CERA used in clinical practice are lower than those recommended on label, which directly influences cost and treatment efficiency. Cost stratification based on iron deposits has shown that patients with low TSI or ferritin require higher doses and consequently an associated higher cost. Thus, to guarantee adequate iron levels is essential in the rational use of ESAs.
authors.affiliation: Pharmacy Service, Gregorio Marañón University General Hospital, Doctor Esquerdo 46, 28007 Madrid, Spain. vescudero.hgugm@salud.madrid.org
authors.forename: Vicente
authors.initials: V
authors.lastname: Escudero-Vilaplana
authors.forename: Concepción
authors.initials: C
authors.lastname: Martínez-Nieto
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: López-Gómez
authors.forename: Almudena
authors.initials: A
authors.lastname: Vega-Martínez
authors.forename: José María
authors.initials: JM
authors.lastname: Bellón-Cano
authors.forename: María
authors.initials: M
authors.lastname: Sanjurjo-Sáez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D003365:Costs and Cost Analysis; D000068256:Darbepoetin alfa; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D004348:Drug Labeling; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007501:Iron / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010530:Peritoneal Dialysis; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000191:economics / Q000628:therapy; D013030:Spain; D062606:Tertiary Care Centers
chemical_list: D006397:Hematinics; C508420:continuous erythropoietin receptor activator; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D007501:Iron