Economic Burden and Health-Related Quality of Life Associated with Current Treatments for Anaemia in Patients with CKD not on Dialysis: A Systematic Review

Abstract

BackgroundThe cost and health-related quality of life (HRQoL) burden associated with treatments for anaemia of chronic kidney disease (CKD) is not well characterized among non-dialysis-dependent (NDD) patients.ObjectiveOur objective was to review the literature on costs and HRQoL associated with current treatments for anaemia of CKD among NDD patients.MethodsThe Cochrane Library, MEDLINE, Embase, NHS EED, and NHS HTA databases were searched for original studies published in English between 1 January 2000 and 17 March 2017. The following inclusion criteria were applied: adult population; primary focus was anaemia of CKD; patients received iron supplementation, red blood cell transfusion, or erythropoiesis-stimulating agents (ESAs); and reported results on HRQoL and/or costs. Studies that included NDD patients, did not compare different treatments, and had relevant designs were retained. HRQoL and cost outcomes were summarized in a narrative synthesis.ResultsIn total, 16 studies met the inclusion criteria: six randomized controlled trials, four prospective single-arm trials, three retrospective studies, one prospective observational study, one simulation study, and one cross-sectional survey. All included ESAs. Treatment of anaemia (compared with no treatment) was associated with HRQoL improvements in five of six studies and lower costs in four of four studies. Treatment aiming for higher haemoglobin targets (compared with lower targets) resulted in modest HRQoL improvements, higher healthcare resource utilization (HRU), and higher costs.ConclusionsIn NDD patients, untreated anaemia of CKD leads to higher costs, higher HRU, and lower HRQoL compared with initiating anaemia treatment. Relative to aiming for lower haemoglobin targets with ESAs, higher targets conferred modest HRQoL improvements and were associated with higher HRU.

Epidemiology and outcomes in patients with anemia of CKD not on dialysis from a large US healthcare system database: a retrospective observational study

“…Anemia of chronic kidney disease (CKD) is associated with increased risk of cardiovascular events and mortality, increased healthcare resource utilization (HCRU), and reduced health-related quality of life (HRQoL) [ 1 – 6 ]. While the prevalence of anemia increases with CKD severity [ 7 – 9 ], anemia also imparts a substantial healthcare burden in early-stage CKD [ 7 ].…”

“…Marked reduction in ESA use has resulted in a shift towards less intensive therapy and lower Hb treatment targets in patients with anemia of CKD [ 8 , 20 , 21 ]. Notably, many patients with CKD not on dialysis do not receive any anemia treatment [ 7 , 22 ], despite some evidence that untreated versus treated anemia is associated with higher HCRU and decreased HRQoL [ 5 , 6 ]. Moreover, treating anemia of CKD can reduce the requirement for RBC transfusions, and thus associated risks from transfusion-related reactions and the development of alloantibodies [ 23 ].…”

Prediction of anemia and estimation of hemoglobin concentration using a smartphone camera

“…Hemoglobin values which define anemia are determined by the World Health Organization (WHO) and are different for males, females, and children [1]. The classic symptoms of anemia-fatigue, dizziness or lightheadedness, headache, shortness of breath, and difficulty concentrating-can lead to major social and economic consequences such as lost wages and medical care [2,3] contingent on this common co-morbidity. Severe anemia is often a sequela of malnutrition, parasitic infections or underlying disease and is a significant risk factor for morbidity and mortality, especially in vulnerable populations such as children, the elderly and the chronically ill [4,5].…”

Anemia among Chinese patients with chronic kidney disease and its association with quality of life - results from the Chinese cohort study of chronic kidney disease (C-STRIDE)

“…HRQoL provides a comprehensive appraisal of disease burden, incorporating assessment of symptoms, functional capacity, and well-being related to an effective treatment. A recent systematic review [ 9 ] showed that treatment of anemia comparing with untreated anemia among patients with CKD was associated improvement of HROoL. However, the aimed of higher hemoglobin level may not be necessary, which has a connection with a certain outcome of HROoL improvement.…”