An Economic Evaluation of Erythropoiesis-Stimulating Agents in CKD

Clement, Fiona; Klarenbach, Scott; Wiebe, Natasha; Hemmelgarn, Brenda R.; Manns, Braden

doi:10.1053/j.ajkd.2010.07.015

Cited by 29 publications

(68 citation statements)

References 47 publications

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“…6 The class of ESA includes the short-acting forms Epoetin Alpha and Epoetin Beta (EpoB), and the long-acting ones: darbepoetin and the pegylated erythropoietin continuous erythropoietin receptor activator (CERA). 7 Understanding the relative cost-utility of those treatments is of importance to both clinicians and health care reimbursement authorities, as the acquisition costs of all ESAs are relatively high and are among the top drug expenditures of hospitals, health care payers, and providers. [7][8][9][10] Although all of previous health economic studies focused their analysis on short-acting ESA, CERA as the last one to be introduced in clinical practice has not been well studied yet.…”

Section: Maoujoud Et Almentioning

confidence: 99%

“…7 Understanding the relative cost-utility of those treatments is of importance to both clinicians and health care reimbursement authorities, as the acquisition costs of all ESAs are relatively high and are among the top drug expenditures of hospitals, health care payers, and providers. [7][8][9][10] Although all of previous health economic studies focused their analysis on short-acting ESA, CERA as the last one to be introduced in clinical practice has not been well studied yet. 1,7,9,11 The purpose of this study was to determine the cost-utility of treating dialysis patients with CERA once monthly or EpoB thrice weekly compared with a strategy of managing anemia without ESAs.…”

Section: Maoujoud Et Almentioning

confidence: 99%

“…Utility ranges from 0, representing the worst imaginable health, to 1, representing perfect health. 7,18 Considering previous studies, there is a continuous improvement in QOL with the increase in Hb level using ESA, 1,17,19 we determinate the QALYs in our model at three Hb ranges: low Hb range (9-10.5 g/dL), high Hb range (.12 g/dL), and intermediate Hb range (10.5-12 …”

Section: Quality Of Lifementioning

confidence: 99%

“…The utility estimate for dialysis patients treated with ESA was based on the published meta-analysis, randomized trials, and cohorts studies comparing different Hb levels achieved 7,19,20 and from recent studies evaluating QOL in CHP. 17 The average utility score for CHP treated with ESA and achieving Hb in the range 10.5-12 g/dL was estimated at 0.64, 7,17,[21][22][23] and at 0.63 for patients in the lower Hb range. 3,7,22 As there is no evidence that utility scores continue to improve, once Hb level rise above 12.0, we considered only one utility score for all Hb above 12 g/dL at 0.65.…”

mentioning

confidence: 99%

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The cost-utility of treating anemia with continuous erythropoietin receptor activator or Epoetin versus routine blood transfusions among chronic hemodialysis patients

Maoujoud

Ahid

Cherrah

2016

IJNRD

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Objective: The purpose of this study was to determine the cost-utility of treating anemic dialysis patients with continuous erythropoietin receptor activator (CERA) once monthly or Epoetin Beta (EpoB) thrice weekly compared with a reference strategy of managing anemia with red blood cell transfusion (RBCT). Methods: Cost-utility analysis study design. Decision analysis model, National health care payer, over 1 year with the publicly funded health care system. Chronic hemodialysis patients with renal anemia were included. The outcome marker of this study was the incremental cost per quality-adjusted life-year (QALY) gained (incremental cost-utility ratio [ICUR]) of CERA or EpoB relative to RBCT. Results: The total cost per patient (in US$) was estimated at $2,176.37, $4,107.01, and $4,356.69 for RBCT, CERA, and EpoB, respectively. The cost-utility ratio was calculated at 4, 423.52, 6,955.50, and 7,406.38 $/QALY for RBCT, CERA, and EpoB, with an ICUR of CERA and EpoB in relation to RBCT at 19,606.40 and 22,466.09 $/QALY, respectively. In sensitivity analysis, the model was most sensitive to hospitalization costs, hospital stay, and annual number of RBCT units. Also, assuming utility and survival improvement with erythropoiesis stimulating agents use resulted in a decrease in ICUR at 13,429 $/QALY for CERA and 15,331 $/QALY for EpoB. In probabilistic sensitivity analysis, the main results of our model were unchanged; CERA and EpoB were more costly and more effective than RBCT below a threshold of 19,500 $/QALY. CERA was the best option for a willingness to pay over 19,500 $/QALY. Limitations: Some model parameters were obtained from observational data, the comparator RBCT is not the standard of care. Conclusion: Our study suggests that managing anemia in dialysis patients with CERA or EpoB may result in better outcomes with higher overall costs. Considering different assumptions, we found substantial variability in the estimates of the cost-utility and incremental of using CERA or EpoB.

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Section: Maoujoud Et Almentioning

confidence: 99%

Section: Maoujoud Et Almentioning

confidence: 99%

Section: Quality Of Lifementioning

confidence: 99%

mentioning

confidence: 99%

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The cost-utility of treating anemia with continuous erythropoietin receptor activator or Epoetin versus routine blood transfusions among chronic hemodialysis patients

Maoujoud

Ahid

Cherrah

2016

IJNRD

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“…As such, both the costing and the cost-utility analysis work are novel. Because improving care of remote-and rural-dwellers continues to be a high priority for governments around the world (24-26), our results are relevant for decision makers, particularly given that this clinic seems cost-effective by accepted standards, and are markedly lower than for other interventions in common use for patients with (27,28) and without CKD (29)(30)(31).…”

Section: Discussionmentioning

confidence: 96%

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

Wiebe

Klarenbach

Chui

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives This study aimed to determine whether opening a new clinic in a remote region would be a cost-effective means of improving care for remote-dwellers with CKD.Design, setting, participants, & measurements This study is a cost-utility analysis from a public payer's perspective over a lifetime horizon, using administrative data from a large cohort of adults with stage 3b-4 CKD in Alberta, Canada. The association between the distance from each simulated patient's residence and the practice location of the closest nephrologist and clinical outcomes (quality of care, hospitalization, dialysis, and death) were examined. A Markov 6-month cycle economic decision model was analyzed; estimates of the effect of a new clinic were based on the association between residence location, resource use, and outcomes. Costs are reported in 2009 Canadian dollars.Results The costs for equipping and operating a clinic for 321 remote-dwelling patients were estimated at $25,000 and $250,000/yr, respectively. The incremental cost-utility ratios (ICURs) ranged from $4000 to $8000/qualityadjusted life-year under most scenarios. However, if reducing distance to nephrologist care does not alter mortality or hospitalization among remote-dwellers, the cost-effectiveness becomes less attractive. All other one-way sensitivity analyses had negligible effects on the ICUR.Conclusions Given the low costs of equipping and operating new clinics, and the very attractive ICUR relative to other currently funded interventions, establishing new clinics for remote-dwellers could play an important role in efficiently improving outcomes for patients with CKD. High-quality controlled studies are required to confirm this hypothesis.

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Chronic Kidney Disease Management in Developing Countries

Badro

2023

Handbook of Medical and Health Sciences in Developing Countries

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An Economic Evaluation of Erythropoiesis-Stimulating Agents in CKD

Cited by 29 publications

References 47 publications

The cost-utility of treating anemia with continuous erythropoietin receptor activator or Epoetin versus routine blood transfusions among chronic hemodialysis patients

The cost-utility of treating anemia with continuous erythropoietin receptor activator or Epoetin versus routine blood transfusions among chronic hemodialysis patients

Adding Specialized Clinics for Remote-Dwellers with Chronic Kidney Disease

Chronic Kidney Disease Management in Developing Countries

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