Cost Analysis of an Intravenous to Subcutaneous Epoetin α Conversion

Wazny, Lori D; Raymond, Colette B; Sood, Amy R.; Eng, Amanda; Verrelli, Mauro

doi:10.1159/000357052

Cited by 4 publications

(4 citation statements)

References 44 publications

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“…SC epoetin was associated with a yearly cost savings of US$1135 per patient. 48 A meta-analysis by Besarab et al concluded that the cost of epoetin was reduced substantially when administered via route of SC in comparison to IV. 49 SC epoetin is twice as efficient as IV epoetin for the treatment of anemia in hemodialysis patients, with a dose saving of 53% ( P <0.001).…”

Section: Resultsmentioning

confidence: 99%

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

Jin¹,

Zhu²,

Chen³

et al. 2015

PPA

125

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BackgroundIntravenous (IV), intramuscular (IM), and subcutaneous (SC) are the three most frequently used injection routes in medication administration. Comparative studies of SC versus IV, IM versus IV, or IM versus SC have been sporadically conducted, and some new findings are completely different from the dosage recommendation as described in prescribing information. However, clinicians may still be ignorant of such new evidence-based findings when choosing treatment methods.MethodsA literature search was performed using PubMed, MEDLINE, and Web of Sciences™ Core Collection to analyze the advantages and disadvantages of SC, IV, and IM administration in head-to-head comparative studies.Results“SC better than IV” involves trastuzumab, rituximab, antitumor necrosis factor medications, bortezomib, amifostine, recombinant human granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor, recombinant interleukin-2, immunoglobulin, epoetin alfa, heparin, and opioids. “IV better than SC” involves ketamine, vitamin K1, and abatacept. With respect to insulin and ketamine, whether IV has advantages over SC is determined by specific clinical circumstances. “IM better than IV” involves epinephrine, hepatitis B immu-noglobulin, pegaspargase, and some antibiotics. “IV better than IM” involves ketamine, morphine, and antivenom. “IM better than SC” involves epinephrine. “SC better than IM” involves interferon-beta-1a, methotrexate, human chorionic gonadotropin, hepatitis B immunoglobulin, hydrocortisone, and morphine. Safety, efficacy, patient preference, and pharmacoeconomics are four principles governing the choice of injection route. Safety and efficacy must be the preferred principles to be considered (eg, epinephrine should be given intramuscularly during an episode of systemic anaphylaxis). If the safety and efficacy of two injection routes are equivalent, clinicians should consider more about patient preference and pharmacoeconomics because patient preference will ensure optimal treatment adherence and ultimately improve patient experience or satisfaction, while pharmacoeconomic concern will help alleviate nurse shortages and reduce overall health care costs. Besides the principles, the following detailed factors might affect the decision: patient characteristics-related factors (body mass index, age, sex, medical status [eg, renal impairment, comorbidities], personal attitudes toward safety and convenience, past experience, perception of current disease status, health literacy, and socioeconomic status), medication administration-related factors (anatomical site of injection, dose, frequency, formulation characteristics, administration time, indication, flexibility in the route of administration), and health care staff/institution-related factors (knowledge, human resources).ConclusionThis updated review of findings of comparative studies of different injection routes will enrich the knowledge of safe, efficacious, economic, and patient preference-oriented medication administration as well as...

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Section: Resultsmentioning

confidence: 99%

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

Jin¹,

Zhu²,

Chen³

et al. 2015

PPA

125

View full text Add to dashboard Cite

show abstract

“…This may be due to the routine use of the IV route by HD staff [16] as well as the issue of pain or 'stinging' or discomfort at the injection site associated with the initial use of SC epoetin-alfa which some studies have cited in the past [42]. The KDIGO guidelines have also cited 'pain' secondary to SC administration, in terms of using short-acting ESAs, as a reason to prefer IV EPO administration, referring to the results of a single centre trial of 30 patients [8,26]. In a randomized, un-blinded trial carried out by Kaufman et al among 208 patients, 86% of the 107 candidates who received SC epoetin injections reported experiencing pain as none to mild [43].…”

Section: Convenience Of Drug Administrationmentioning

confidence: 99%

“…For non-HD patients, the SC route may be more generally convenient due to the lack of a continuous IV access, the ease of self administration, comparatively lower dosage, less frequent hospital visits, a reduced dosing frequency and ultimately reduced costs. Even in HD patients, the SC route has been tied to similar advantages and may therefore be more beneficial overall as compared to the IV route, despite the obvious convenience that an arteriovenous fistula confers to IV EPO administration [ 13 - 17 , 19 , 26 - 28 , 31 - 35 ]. This may be particularly beneficial in low-income countries where affordability and access to newer, longer acting ESAs may be difficult [ 40 ].…”

Section: Reviewmentioning

confidence: 99%

Erythropoietin Administration for Anemia Due to Chronic Kidney Disease - Subcutaneous OR Intravenous, What Do We Know So Far?

Shahab

Khan

2020

Cureus

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The prevalence of anemia in chronic kidney disease (CKD) patients is almost twice that of the normal population and its severity increases exponentially as the disease worsens, dramatically affecting the quality of an individual's life. The advent of erythropoiesis stimulating agents (ESA) in the 1980s saw a revolutionary change in the treatment of anemia in CKD patients, drastically improving quality of life (QoL), overall health and reducing the need for blood transfusions. Numerous ESAs have been developed ever since and are in current use, with the primary routes of administration being intravenous (IV) and subcutaneous (SC) injections. Their use, however, has stirred significant controversy over the last two decades. Additionally, despite numerous studies and trials, the latest international recommendations for their use do not provide clear cut guidance with well-grounded evidence on the recommended route of administration for different sets of patients. Instead, this decision has mainly been left up to the physician's discretion, whilst keeping certain key factors in mind. This review shall summarize, discuss and compare the findings of previous studies on various factors governing the two aforementioned routes of administration and identify areas that need further exploration.

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“…The financial and safety concerns with ESA use have resulted in implementation of ESA-related cost management programs, primarily in the outpatient setting, with varying degrees of success. Programs have focused on converting ESAs from intravenous (IV) to subcutaneous (SubQ) administration [ 14 ], converting from a shorter acting to a longer acting ESA (e.g. epoetin alfa to darbepoetin alfa) [ 15 ], implementing nurse-driven anemia management protocols [ 16 ], pharmacist-managed ESA clinics, pharmacist-led management protocols [ 17 , 18 ], and other strategies [ 19 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy: A cross-sectional study

et al. 2017

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BackgroundErythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings.ObjectiveThe primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs.MethodsThis retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively.ResultsA total of 242 patients were included. The majority of the prescribers (77%) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95% CI: 1.03–1.65) and ferritin (OR = 3.91; 95% CI: 1.23–12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95% CI:1.05–1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (β = 0.02349; P = 0.895).ConclusionsPrescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.

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Cost Analysis of an Intravenous to Subcutaneous Epoetin α Conversion

Cited by 4 publications

References 44 publications

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection

Erythropoietin Administration for Anemia Due to Chronic Kidney Disease - Subcutaneous OR Intravenous, What Do We Know So Far?

Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy: A cross-sectional study

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