Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study

Burnier, Michel; Douchamps, J; Tanghe, Ann; Demey, Jan; Perrault, Louise; Foster, Claire; Robbins, Sean

doi:10.3111/13696990902925416

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…Recent data already argue that the introduction of CERA could offer relevant cost savings compared to a conventional first-generation ESA (epoetin [EPO] alpha or beta) therapy: firstly, the cost-effectiveness of pegylated drugs has been indicated in various clinical settings;26 secondly, the nursing staff costs in particular are directly affected by the dosing frequency of the ESA 27–29. Finally, a landmark study by Schiller et al30 demonstrated that use of a once-monthly ESA to correct anemia in dialysis patients may provide substantial time, resource, and cost savings.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

Schmid¹

2014

CEOR

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BackgroundErythropoiesis-stimulating agents (ESAs) are the mainstay of anemia therapy. Continuous erythropoietin receptor activator (CERA) is a highly effective, long-acting ESA developed for once-monthly dosing. A multitude of clinical studies has evaluated the safety and efficiency of this treatment option for patients with renal anemia. In times of permanent financial pressure on health care systems, the cost-effectiveness of CERA should be of particular importance for payers and clinicians.ObjectiveTo critically analyze, from the nephrologists’ point of view, the published literature focusing on the cost-effectiveness of CERA for anemia treatment.MethodsThe detailed literature search covered electronic databases including MEDLINE, PubMed, and Embase, as well as international conference abstract databases.ResultsPeer-reviewed literature analyzing the definite cost-effectiveness of CERA is scarce, and most of the available data originate from conference abstracts. Identified data are restricted to the treatment of anemia due to chronic kidney disease. Although the majority of studies suggest a considerable cost advantage for CERA, the published literature cannot easily be compared. While time and motion studies clearly indicate that a switch to CERA could minimize health care staff time in dialysis units, the results of studies comparing direct costs are more ambivalent, potentially reflecting the differences between health care systems and variability between centers.ConclusionAnalyzed data are predominantly insufficient; they miss clear evidence and have to thus be interpreted with great caution. In this day and age of financial restraints, results from well-designed, head-to-head studies with clearly defined endpoints have to prove whether CERA therapy can achieve cost savings without compromising anemia management.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

Schmid¹

2014

CEOR

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“…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%

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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“…While short-acting originator (and, more recently, their biosimilar) ESAs remain available, using the subsequently developed longer-acting ESAs, which require less frequent dosing, appears to reduce the burden of administration on patients, caregivers and healthcare professionals [10]. The two longer-acting ESAs, darbepoetin alfa (DA) and methoxy polyethylene glycol-epoetin beta (PEG-Epo), combine a significantly increased half-life with a lower binding affinity for the EPO receptor, allowing them to stimulate erythropoiesis for longer periods and to be administered less frequently [9, 11].…”

Section: Introductionmentioning

confidence: 99%

Preservation of Anemia Control and Weekly ESA Dosage After Conversion from PEG-Epoetin Beta to Darbepoetin Alfa in Adult Hemodialysis Patients: The TRANSFORM Study

Donck

González-Tabarés²,

Chanliau³

et al. 2014

Adv Ther

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IntroductionThere is scant real-world information on switching treatment for anemia associated with chronic kidney disease (CKD) from methoxy polyethylene glycol-epoetin beta (PEG-Epo) to darbepoetin alfa (DA). TRANSFORM was a multi-center, observational study designed to describe the time course of hemoglobin (Hb) concentration (primary outcome measure) and other parameters of clinical management of anemia in European hemodialysis patients in clinical practice before and after a switch from PEG-Epo to DA.MethodsEligible subjects were adult patients with CKD dialyzed at European dialysis centers for ≥26 weeks and treated with PEG-Epo for ≥14 weeks immediately prior to being switched to DA and no earlier than January 2011. Erythropoiesis-stimulating agent doses and Hb values were recorded for the 14-week pre-switch and 26-week post-switch periods.ResultsOf the 1,027 eligible patients enrolled at 42 hemodialysis centers in 7 European countries, 785 were included in analyses. Mean (95% confidence interval [CI]) Hb was generally stable: 11.19 (11.11, 11.26), 11.48 (11.40, 11.57), and 11.29 (11.20, 11.37) g/dL at month −1 pre-switch and months 3 and 6 post-switch, respectively. The geometric mean (95% CI) PEG-Epo dose at month −1 was 27.4 (26.0, 28.8) µg/week; DA dose was 29.4 (27.9, 30.9), 23.3 (21.9, 24.9), and 25.6 (24.1, 27.1) µg/week at months 1, 4, and 6, respectively. The geometric mean (95% CI) dose ratio at switching was 1.06 (1.01, 1.11). When stratifying by dose-ratio categories <0.8, 0.8–1.2, and >1.2 at switching, mean DA dose and Hb converged within narrow ranges by month 6 post-switch: 23.9–27.0 µg/week and 11.1–11.5 g/dL, respectively. Hb excursions <10 g/dL were less frequent post-switch versus pre-switch.ConclusionMean Hb values remained within a narrow range following switching from PEG-Epo to DA in this population of hemodialysis patients. Time trends of mean Hb and DA dose indicate that physicians titrated DA doses post-switch, to attain Hb concentrations comparable to those attained pre-switch with PEG-Epo.FundingAmgen (Europe) GmbH, Zug, Switzerland.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0161-5) contains supplementary material, which is available to authorized users.

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Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study

Abstract: ESA administration has quantifiable labour and material costs which are affected by dosing frequency.

Cited by 8 publications

References 5 publications

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

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

Preservation of Anemia Control and Weekly ESA Dosage After Conversion from PEG-Epoetin Beta to Darbepoetin Alfa in Adult Hemodialysis Patients: The TRANSFORM Study

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