title: The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease.
abstract: BACKGROUND
  Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents (ESAs) for managing chronic anemia in persons with chronic kidney disease (CKD), there are differences in the recommended hemoglobin (Hb) treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3-4.
  
  
  RESULTS
  The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3-4 (i.e., not on dialysis) and anemia created from the 1999-2010 National Health and Nutrition Examination Survey. Incremental cost-effectiveness ratios (ICERs), computed as incremental cost divided by incremental quality adjusted life years (QALYs), were assessed for Hb targets of 10 g/dl to 13 g/dl at 0.5 g/dl increments. Targeting a Hb of 10 g/dl resulted in an ICER of $32,111 compared with no treatment and targeting a Hb of 10.5 g/dl resulted in an ICER of $32,475 compared with a Hb target of 10 g/dl. QALYs increased to 4.63 for a Hb target of 10 g/dl and to 4.75 for a target of 10.5 g/dl or 11 g/dl. Any treatment target above 11 g/dl increased medical costs and decreased QALYs.
  
  
  CONCLUSIONS
  In persons over age 30 with CKD stages 3-4, anemia treatment is most cost-effective when targeting a Hb level of 10.5 g/dl. This study provides important information for framing guidelines related to treatment of anemia in persons with CKD.
authors.affiliation: RTI International, Research Triangle Park, North Carolina, United States of America.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Yarnoff
authors.affiliation: RTI International, Research Triangle Park, North Carolina, United States of America.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.affiliation: RTI International, Research Triangle Park, North Carolina, United States of America.
authors.forename: Siobhan A
authors.initials: SA
authors.lastname: Simpson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Meda E
authors.initials: ME
authors.lastname: Pavkov
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Nilka R
authors.initials: NR
authors.lastname: Burrows
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Sundar S
authors.initials: SS
authors.lastname: Shrestha
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
authors.affiliation: Merck Research Laboratories, North Wales, Pennsylvania, United States of America.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhuo
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood / Q000150:complications* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D058990:Molecular Targeted Therapy / Q000191:economics*; D019057:Quality-Adjusted Life Years; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D006454:Hemoglobins