title: International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study.
abstract: For years, erythropoiesis-stimulating agent (ESA) use among patients on dialysis was much higher in the United States than in Europe or Japan. Sweeping changes to dialysis reimbursement and regulatory policies for ESA in the United States in 2011 were expected to reduce ESA use and hemoglobin levels. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS) data from 7129 patients in 223 in-center hemodialysis facilities (average per month) to estimate and compare time trends in ESA dose and hemoglobin levels among patients on hemodialysis in the United States, Germany, Italy, Spain, the United Kingdom, and Japan. From 2010 to 2013, substantial declines in ESA use and hemoglobin levels occurred in the United States but not in other DOPPS countries. Between August of 2010 and April of 2013, mean weekly ESA dose in the United States decreased 40.4% for black patients and 38.0% for nonblack patients; mean hemoglobin decreased from 11.5 g/dl in black patients and 11.4 g/dl in nonblack patients to 10.6 g/dl in both groups. In 2010 and 2013, adjusted weekly ESA doses per kilogram were 41% and 11% lower, respectively, in patients in Europe and 60% and 18% lower, respectively, in patients in Japan than in nonblack patients in the United States. Adjusted hemoglobin levels in 2010 and 2013 were 0.07 g/dl lower and 0.56 g/dl higher, respectively, in patients in Europe and 0.93 and 0.01 g/dl lower, respectively, in patients in Japan than in nonblack patients in the United States. In conclusion, ESA dosing reductions in the United States likely reflect efforts in response to changes in reimbursement policy and regulatory guidance.
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan; Doug.Fuller@ArborResearch.org.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Fuller
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bieber
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan;
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Departments of Epidemiology and Environmental Health Sciences, School of Public Health, Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan;
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.affiliation: Department of Nephrology, Showa University School of Medicine, Shinagawa, Tokyo, Japan;
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Department of Clinical Sciences, Division of Nephrology, Danderyd University Hospital, Stockholm, Sweden; and.
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.affiliation: Department of Nephrology, Ospedale A. Manzoni, Lecco, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan;
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D005060:Europe; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012051:Reimbursement Mechanisms; D006435:Renal Dialysis / Q000191:economics; D014481:United States
chemical_list: D006397:Hematinics
keywords: ESRD; anemia; epoetin; erythropoietin; hemodialysis