title: Cost savings using a protocol approach to manage anemia in a hemodialysis unit.
abstract: BACKGROUND
  National guidelines recommend using anemia management protocols to guide treatment. The objective of this study was to determine if an anemia management protocol would improve hemoglobin (Hgb) indices in hemodialysis patients and to measure whether the protocol would reduce the use and cost of darbepoetin alfa (DBO) and intravenous (IV) iron in hemodialysis patients.
  
  
  METHODS
  An anemia management protocol was created and implemented for hemodialysis patients at our institution. A retrospective observational review of the use of DBO and IV iron as well as changes in Hgb, transferrin saturation and ferritin in 174 patients was conducted 6 months before and after implementation of the anemia protocol.
  
  
  RESULTS
  The number of Hgb measurements in the target range increased from 44.3 to 46.0% (p = 0.48) after protocol implementation. The mean weekly dose of DBO was reduced from 34.56 ± 31.12 to 31.11 ± 28.64 μg post-protocol implementation (p = 0.011), which translated to a cost savings of USD 41,649 over 6 months. The mean monthly IV iron dose also decreased from 139.56 ± 98.83 to 97.65 ± 79.05 mg (p < 0.005), a cost savings of USD 18,594 over the same time period.
  
  
  CONCLUSIONS
  The use of an anemia management protocol resulted in the deprescribing of DBO and iron agents while increasing the number of patients in the target Hgb range, which led to significant cost savings in the treatment of anemia.
authors.affiliation: University Health Network, Toronto, Ont., Canada.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Charlesworth
authors.forename: Robert M
authors.initials: RM
authors.lastname: Richardson
authors.forename: Marisa
authors.initials: M
authors.lastname: Battistella
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D002985:Clinical Protocols; D017046:Cost Savings; D000068256:Darbepoetin alfa; D016527:Drug Costs; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005293:Ferritins / Q000378:metabolism; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use*; D006436:Hemodialysis Units, Hospital; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014168:Transferrin / Q000378:metabolism
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D014168:Transferrin; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D005293:Ferritins; D007501:Iron