Original Paper

Cost Should Be the Principal Determinant of Choice of Erythropoiesis-Stimulating Agent in Chronic Haemodialysis Patients
Aisling E. Courtney, Peter T. McNamee, A. Peter Maxwell

Regional Nephrology Unit, Belfast City Hospital, Belfast, Ireland

Address of Corresponding Author

Nephron Clin Pract 2007;107:c14-c19 (DOI: 10.1159/000106507)

  Key Words

• Erythropoiesis-stimulating agents, cost
• Haemodialysis
• Renal anaemia

  Abstract

Background/Aims: Erythropoiesis-stimulating agents (ESAs) are effective in the management of the anaemia of chronic kidney disease but add substantially to the treatment costs. We performed a comparison cross-sectional analysis of ESA prescribing in 4 dialysis centres in Northern Ireland. Methods: The ESA prescription and current haemoglobin (Hb) concentration for all patients on haemodialysis (HD) treatment for at least 3 months was extracted from the renal data system. Results: A total of 403 patients were analysed, 184 (46%) were prescribed epoetin and 219 (54%) darbepoetin . The mean Hb concentrations for both agents were comparable overall (Hb = 11.4 and 11.7 g/dl, p = 0.13), and for subcutaneous (SC) and intravenous (IV) administration: epoetin 11.5 g/dl (n = 119) and 11.4 g/dl (n = 65) (p = 0.70), and darbepoetin 11.8 g/dl (n = 39) and 11.6 g/dl (n = 180) (p = 0.49). The mean weekly dose was 7,941 units of epoetin with SC and 9,200 units with IV administration (p = 0.10), and 45 µg SC and 46 µg IV of darbepoetin (p = 0.94). The weekly cost of achieving equivalent Hb levels was GBP 61.86 (EUR 90.57/USD 115.68) with SC and GBP 71.67 (EUR 104.93/USD 134.02) with IV epoetin , and GBP 70.78 (EUR 103.63/USD 132.36) with SC and GBP 72.18 (EUR 105.68/USD 134.98) with IV darbepoetin . Conclusions: Epoetin and darbepoetin are equally effective ESAs and the choice of ESA prescribed in stable HD patients should be determined by cost.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Aisling E. Courtney
Regional Nephrology Unit, Belfast City Hospital - Level 11
Lisburn Road
Belfast BT9 7AB (Ireland)
Tel. +44 289 032 9241, Fax +44 289 026 3535, E-Mail aecourtney@doctors.org.uk

  Article Information

Received: December 14, 2006
Accepted: April 1, 2007
Published online: July 31, 2007
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 2, Number of References : 22