Costs of managing anemia with erythropoiesis‐stimulating agents during hemodialysis: A time and motion study

Abstract

Use of erythropoiesis-stimulating agents (ESAs) presents a significant time and cost burden in the management of anemia of chronic kidney disease (CKD). We conducted a prospective, observational, activity-based costing study to estimate the health care personnel time and resulting direct medical costs associated with administering epoetin 3 times weekly to patients with end-stage renal disease on dialysis. The study was conducted at 5 US hemodialysis centers. The personnel time and costs were derived from time and motion observations. Predicted time and cost savings were modeled for switching patients to once-monthly ESA therapy. Patients also completed a survey questionnaire to assess their level of CKD knowledge and information needs. Total per-patient-per-year (PPPY) time expended on anemia management with epoetin averaged 608 minutes (range 512-915 minutes), with an average PPPY cost of $548 (range $342-$651). Use of a once-monthly ESA, compared with epoetin, could decrease average PPPY time expenditure by 79% (127 minutes [range 96-173 minutes]) and reduce PPPY costs by 81% ($104 [range $79-$136]). The patient questionnaire reported insufficient education on CKD. Use of a once-monthly ESA to correct anemia in dialysis patients may provide substantial time, resource, and cost savings compared with current treatment practices.

An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients

“…(iv) Cost-related issues have also emerged as an additional hurdle, questioning the cost-benefit value of ESAs to treat anemia in dialysis patients. 15 Successfully achieving all of these requirements can place an additional workload on nephrologists caring for a large number of patients; this is aggravated by the complexity and heterogeneity of the ESKD population, presenting with different medical profiles and diverse, possibly changing, sensitivity to ESAs, leading to the need for more precise, personalized dose adjustments. Given the importance of anemia management for the patient's well-being, developing interactive guided clinical tools to support the physician's work would be a favorable advancement.…”

Peginesatide for Maintenance Treatment of Anemia in Hemodialysis and Nondialysis Patients Previously Treated with Darbepoetin Alfa

“…Results from a prospective observational study indicated that, compared with a thrice-weekly ESA, a once-monthly ESA may reduce injection-related personnel time by 79% (18). Another potential benefit of a once-monthly ESA is that nurses could devote more time to patient assessment and education, which could improve patient safety and satisfaction.…”

“…The frequent dosing requirement is often burdensome to patients and health care providers, and new agents allowing for less frequent dosing are desired. Less frequent dosing of ESAs could potentially allow more time for physicians and nurses to address other issues in patients (18); although this is particularly true in nondialysis patients, less frequent dosing could also decrease the time nurses spend preparing and injecting ESAs in dialysis patients. Darbepoetin alfa, although administered less frequently than epoetin alfa, is dosed up to once per week in dialysis patients (19).…”

Bundled-Rate Legislation for Medicare Reimbursement for Dialysis Services

“…Schiller et al reported results of an observational study that captured activ-ity-based costs of anemia management using epoetin alfa TIW in five U.S. dialysis centers and then modeled hypothetical time and cost savings gained by switching to a once-monthly ESA (54). For epoetin alfa sessions, an average of 608 minutes per patient per year (PPPY) were spent for observed and unobserved tasks, with an average cost of anemia management in these U.S. centers of $548 PPPY.…”