Background A certain number of hospital drugs are listed, at the national level, to be charged to health insurance in addition to hospital stay fees, based on diagnosis related group (DRG) tariffs. This list is regularly updated with new entries as innovative and expensive drugs reach the market. When they begin to be used more widely and/or their cost decreases, drugs should be removed from this list and put back into the DRG system. This was the case for erythropoiesis stimulating agents (ESA) that were removed in March 2014.
Purpose The aim of this study was to evaluate the impact of change in reimbursement system on the use of ESA for the treatment of anaemia in patients with chronic kidney disease (CKD) on dialysis.
Material and methods A comparison of practices between the 22 month-period before and after ESA withdrawal from the list was conducted retrospectively. All adult patients with CKD on dialysis and receiving ESA treatment during one of these two periods were included. The following criteria were collected: patient age and sex, time on dialysis, primary kidney disease, monthly haemoglobin concentration, iron and ESA total consumption.
Results 569 patients were included in the first period (1 May 2012–29 February 2014), 585 in the second period (1 March 2014–31 December 2015). The characteristics of the patients were similar between the two patient groups: median age (67 years), sex ratio (1.5), median time on dialysis (3 years) and primary kidney disease. Median haemoglobin level was 110.5 g/L during the first period compared with 108.8 g/L during the second period (p<0.05). The average consumption of iron increased significantly during the second period, and the total consumption of ESA increased proportionally to the number of patients.
Conclusion This study showed a lower haemoglobin rate target (which can also be related to the evolution of the recommendations) and an increase in iron use, but no decrease in ESA consumption. It seems that the reimbursement change had little impact on the use of ESA for treatment of anaemia in patients on dialysis. Further criteria, such as the Charlson comorbidity index, erythropoietin resistance index and number of transfusions, should be evaluated to explain these results and confirm the clinical relevance of the effects observed.
No conflict of interest
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