title: Drug Utilization Patterns and Costs of Erythropoiesis-Stimulating Agents in an Outpatient Setting in Greece.
abstract: Anemia in the elderly is often related to a higher prevalence of chronic diseases such as chronic kidney failure, arthritis, and malignancy. Erythropoiesis-stimulating agents (ESAs) have been used for years to effectively treat anemia and when used appropriately can substantially improve the health status and quality of life of older adults. Following the 2008 recession in Greece, the government introduced ESA price control restrictions, but no prescribing restrictions, in an effort to reduce drug expenditure.
  
  
  OBJECTIVE
  ESA prescribing patterns and treatment costs were analyzed to determine inappropriate or appropriate use of these agents and related health care resources in Greece.
  
  
  METHODS
  A retrospective register-based drug utilization study was carried out using data from prescriptions dispensed at the public pharmacy of the largest social insurance fund (IKA-ETAM), for patients receiving ESAs over a six-month period. For each patient, demographic data, ESA dosage regimen, treatment indication and cost, prescriber specialty, and prescription origin were recorded.
  
  
  RESULTS
  A total of 14,387 prescriptions from 6,074 patients (median age 74 years) were reviewed. A substantial number of patients (13.5%) were treated for off-label indications, for which the average cost per patient per indication was higher. ESA dosage/frequency of administration varied but was in accordance with recommendations. The percentage of patients who received innovator and biosimilar erythropoietin (EPO) was 88% and 12%, respectively.
  
  
  CONCLUSIONS
  For the optimization of ESA utilization and the reduction of treatment costs, strict ESA prescription monitoring, development of registries, and criteria for off-label indications and biosimilar use in naive patients under the umbrella of risk-sharing agreements should be proposed.
authors.affiliation: Faculty of Pharmacy, Laboratory of Biopharmaceutics-Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Papachristos
authors.forename: Chara
authors.initials: C
authors.lastname: Kani
authors.forename: Panagiota
authors.initials: P
authors.lastname: Litsa
authors.forename: Georgia
authors.initials: G
authors.lastname: Valsami
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Souliotis
authors.forename: Maria
authors.initials: M
authors.lastname: Saridi
authors.forename: Sophia
authors.initials: S
authors.lastname: Markantonis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000740:Anemia / Q000188:drug therapy* / Q000191:economics; D059451:Biosimilar Pharmaceuticals / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D004921:Erythropoietin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006115:Greece; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D059451:Biosimilar Pharmaceuticals; D006397:Hematinics; D004921:Erythropoietin