Dosing patterns and costs of erythropoietic agents in patients with chronic kidney disease not on dialysis in managed care organizations

Duh, Mei Sheng; Mody, Samir H.; McKenzie, R. Scott; Lefèbvre, Patrick; Gosselin, Antoine; Piech, Catherine Tak

doi:10.1016/j.clinthera.2006.09.020

Cited by 17 publications

(12 citation statements)

References 12 publications

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“…Other studies have demonstrated differences in CKD costs based on the type of ESA used and the route of ESA administration. Epoetin treatment has been associated with lower average costs compared with darbepoetin [27,28] , while subcutaneous ESA use has been associated with lower average costs compared with intravenous administration [29] .…”

Section: Discussionmentioning

confidence: 99%

Healthcare Expenditure and Resource Utilization in Patients with Anaemia and Chronic Kidney Disease: A Retrospective Claims Database Analysis

Wish

Schulman

Law

et al. 2009

Kidney Blood Press Res

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Background/Aims: We conducted a retrospective claims database analysis to examine the association of anaemia and anaemia management with healthcare expenditure and utilization in patients with chronic kidney disease (CKD) before the onset of dialysis. Methods: Claims data on patients (aged ≥15 years) with CKD were collected from the Medstat Marketscan® Commercial and Medicare Databases between 2000 and 2005. Using these data, patients were evaluated for anaemia of CKD, anaemia treatment status and healthcare costs and use. Results: Of the 37,105 CKD patients, 9,807 (26%) had incident anaemia; 59% of these received at least one type of anaemia treatment, with 48% receiving an erythropoiesis-stimulating agent. The total adjusted per patient per month healthcare expenditure for all CKD patients was USD 2,749. Patients with anaemia had significantly greater overall expenditure, which was 38% higher than those without anaemia. Total expenditure was 17% higher for untreated versus treated anaemic patients, largely due to higher inpatient expenditure in the untreated cohort. Conclusion: This analysis suggests that the presence of anaemia is associated with greater medical expenditure in patients with CKD. However, we found that anaemia management may help to lower inpatient costs associated with anaemia in the CKD population.

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Section: Discussionmentioning

confidence: 99%

Healthcare Expenditure and Resource Utilization in Patients with Anaemia and Chronic Kidney Disease: A Retrospective Claims Database Analysis

Wish

Schulman

Law

et al. 2009

Kidney Blood Press Res

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“…Several observational studies have described the dose relationship between EPO and darbepoetin alfa [24][25][26][27][28][29][30][31][32][33][34][35] ; however, many of these studies have significant methodological limitations, including not considering the same set of patients who were converted from EPO to darbepoetin alfa, not recognizing the non-proportional dose relationship between the two ESAs, and not adjusting for differences in the populations analyzed. In these studies, dose-only ratio (DOR) is reported, which is a ratio that compares the mean EPO dose in one population to the mean darbepoetin alfa dose in another population.…”

Section: Introductionmentioning

confidence: 99%

Estimate of maintenance EPO to darbepoetin alfa dose conversion ratio in a hospital-based dialysis patient population

Sharma

Yee

Gandra

et al. 2010

Current Medical Research and Opinion

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“…Many studies have attempted to calculate a population-level single dose relationship value, described by previous investigators as a "dose ratio" (DR), using real-world observational data. [16][17][18][19][20][21][22][23][24][25][26][27][28] However, the majority of this work had significant methodological limitations because the underlying data do not represent the same patients who underwent conversion from one ESA to the other (Table 1). [16][17][18][19][21][22][23][24][25][26][27][28] In these studies, researchers used crosssectional designs to compare the mean epoetin alfa dose in one population with the mean darbepoetin alfa dose in another population-per administration, per week, per hospital stay, or cumulative dose per study period-without controlling for equivalent outcomes (Hb levels) or heterogeneity in patient populations.…”

Section: Note: This Article Is the Subject Of An Editorial That Appeamentioning

confidence: 99%

“…[16][17][18][19][20][21][22][23][24][25][26][27][28] However, the majority of this work had significant methodological limitations because the underlying data do not represent the same patients who underwent conversion from one ESA to the other (Table 1). [16][17][18][19][21][22][23][24][25][26][27][28] In these studies, researchers used crosssectional designs to compare the mean epoetin alfa dose in one population with the mean darbepoetin alfa dose in another population-per administration, per week, per hospital stay, or cumulative dose per study period-without controlling for equivalent outcomes (Hb levels) or heterogeneity in patient populations. Another important factor that has not been addressed in reporting the dose relationship in nonconverted [16][17][18][19][21][22][23][24][25][26][27][28] and converted 20 (from one ESA to another) CKD patient populations is the nonproportional dose conversion relationship as a function of ESA dose and treatment stage (initiation versus maintenance).…”

Section: Note: This Article Is the Subject Of An Editorial That Appeamentioning

confidence: 99%

“…[16][17][18][19][21][22][23][24][25][26][27][28] In these studies, researchers used crosssectional designs to compare the mean epoetin alfa dose in one population with the mean darbepoetin alfa dose in another population-per administration, per week, per hospital stay, or cumulative dose per study period-without controlling for equivalent outcomes (Hb levels) or heterogeneity in patient populations. Another important factor that has not been addressed in reporting the dose relationship in nonconverted [16][17][18][19][21][22][23][24][25][26][27][28] and converted 20 (from one ESA to another) CKD patient populations is the nonproportional dose conversion relationship as a function of ESA dose and treatment stage (initiation versus maintenance). Average DRs reported in the literature range from 217:1 to 287:1 epoetin alfa (units [U]): darbepoetin alfa (micrograms [µg]).…”

Section: Note: This Article Is the Subject Of An Editorial That Appeamentioning

confidence: 99%

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Empirical Methods to Calculate an Erythropoiesis-Stimulating Agent Dose Conversion Ratio in Nondialyzed Patients with Chronic Kidney Disease

Horowitz¹,

Agarwal²,

Huang³

et al. 2009

JMCP

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BACKGROUND: Epoetin alfa and darbepoetin alfa are erythropoiesis-stimulating agents (ESAs) indicated for the treatment of anemia in chronic renal failure, including patients on dialysis and patients not on dialysis. Clinical experience demonstrates that the dose conversion ratio (DCR) between epoetin alfa and darbepoetin alfa is nonproportional across the dosing spectrum. However, previous calculations of the dose relationship between epoetin alfa and darbepoetin alfa, described in previous work as the "dose ratio" (DR), (a) used cross-sectional designs (i.e., compared mean doses for patient groups using each ESA) and were therefore vulnerable to confounding or (b) did not adjust for the nonproportional dose relationship. DRs reported in the literature range from 217:1 to 287:1 epoetin alfa (Units [U]):darbepoetin alfa (micrograms [µg]). Payers may need a single DCR that accounts for the nonproportional dose relationship to evaluate the economic implications of converting a nondialyzed patient population with chronic kidney disease (CKD) from epoetin alfa to darbepoetin alfa. OBJECTIVE: To estimate a single mean maintenance DCR between epoetin alfa and darbepoetin alfa in subjects with CKD not receiving dialysis, using methods that take into account the nonproportional dose relationship between the 2 ESAs. METHODS: This was a post-hoc analysis of a subset of patients enrolled in an unpublished, open-label, single arm phase 3 clinical trial (ClinTrial. gov identifier NCT00093977) that was completed in 2006. Although the clinical trial enrolled both dialyzed and nondialyzed patients, the present study used a patient subset comprising nondialyzed patients with CKD previously receiving weekly or every-other-week (Q2W) epoetin alfa who were switched to Q2W darbepoetin alfa to maintain hemoglobin (Hb) levels between 11.0 and 13.0 grams per deciliter. A population mean DCR was estimated using 2 methods: (a) a regression-based method in which the log-transformed (natural logarithm) mean weekly darbepoetin alfa dose over the evaluation period of the study (weeks 25 to 33) was regressed on the log-transformed (natural logarithm) weekly epoetin alfa dose over the 2-week screening period; and (b) a mean ratio method in which the DCR was calculated for each individual patient and then averaged for the study population to give a population-level DCR. Sensitivity analyses estimated the DCR in various subgroups. RESULTS: Of 1,127 patients enrolled in clinical trial NCT00093977, 567 patients on dialysis were excluded. Of the remaining 560 patients, 104 received weekly or Q2W epoetin alfa, were switched to Q2W darbepoetin alfa, received at least 1 non-zero dose of darbepoetin alfa during the evaluation period, and were included in the DCR calculation for the present study. Analysis of the log-log plot for the regression-based method indicated 2 or more possible regression lines with separate slopes. However, based on our a priori analysis plan to estimate a single DCR for the patient sample, the estimated sample mean main...

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Dosing patterns and costs of erythropoietic agents in patients with chronic kidney disease not on dialysis in managed care organizations

Cited by 17 publications

References 12 publications

Healthcare Expenditure and Resource Utilization in Patients with Anaemia and Chronic Kidney Disease: A Retrospective Claims Database Analysis

Healthcare Expenditure and Resource Utilization in Patients with Anaemia and Chronic Kidney Disease: A Retrospective Claims Database Analysis

Estimate of maintenance EPO to darbepoetin alfa dose conversion ratio in a hospital-based dialysis patient population

Empirical Methods to Calculate an Erythropoiesis-Stimulating Agent Dose Conversion Ratio in Nondialyzed Patients with Chronic Kidney Disease

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