Background Situations such as a previous kidney transplant or dialysis may increase the dose requirement of erythropoiesis-stimulating agents (ESAs), which is associated with a higher cost.
Purpose To examine the difference in cost between the use of ESAs for pre-dialysis and dialysis (peritoneal dialysis or haemodialysis) patients and for patients with or without a kidney transplant.
Materials and Methods A descriptive, transversal study was carried out in patients treated with ESAs for anaemia secondary to chronic kidney disease in a tertiary hospital over a month in 2011. ESAs used were: epoetin (α or β), darbepoetin α and continuous erythropoietin receptor activator (CERA). The principal variable was patient-month cost, calculated as the cost of the dose unit for each ESA type (IU or mcg) multiplied by the monthly dose per patient.
Results 333 patients were included. 26.2% had previously had a kidney transplant (10.3% epoetin, 33.3% darbepoetin α, 56.3% CERA). Median [p25, p75] patient-month cost for patients with kidney transplant vs. patients who had not had a kidney transplant was: epoetin (191.3 [95.6, 414.5] euros vs. 103.2 [63.8, 191.3] euros, p = 0.060), darbepoetin α (144.0 [72.0, 288.0] euros vs. 144.0 [72.0, 216.0] euros, p = 0.136) and CERA (196.7 [172.1, 295.0] euros vs. 98.3 [59.0, 147.5] euros, p < 0.001).
30.9% patients were on dialysis (35.0% epoetin, 58.3% darbepoetin α, 6.8% CERA). Median [p25, p75] patient-month cost for patients on dialysis vs. not yet on dialysis was: epoetin (151.1 [74.1, 239.1] euros vs. 92.1 [59.5, 165.6] euros, p = 0.006), darbepoetin α (144.0 [72.0, 216.0] euros vs. 144.0 [67.2, 229.2] euros, p = 0.888) and CERA (393.4 [98.3, 491.7] euros vs. 147.5 [98.3, 196.7] euros, p = 0.035).
Conclusions The cost of epoetin and CERA is greater for both patients with a kidney transplant and patients on dialysis. However there was no difference regarding darbepoetin α.
No conflict of interest.
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