Parameters for successful monthly extended dosing of darbepoetin-alpha in patients undergoing hemodialysis

Trachsler, Johannes; Glück, Z.; Dickenmann, Michael; Gauthier, Thierry; M, Brünisholz; Martin, Pierre‐Yves; Burnier, Michel; Wahl, Christoph; Wüthrich, Rudolf P.

doi:10.5414/cnp71697

Cited by 3 publications

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“…A total of six studies reported cost savings, another study by De Cock47 demonstrated substantial time savings, whereas only two authors32,34 reported slightly higher costs for CERA compared to DA (median costs/patient/month of €147.5 and €105±€26 versus €134.4 and €115±€17, respectively) 32,34,35,38,41,43–45,47. However, it remains unclear whether general conclusions can be drawn from these observations, as many patients may also be successfully managed with a once-monthly dose of DA 55,56…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

Schmid¹

2014

CEOR

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“…In two studies evaluating extended dosing of darbepoetin alfa in dialysis patients (40,41), only a small fraction of patients ultimately received every-4-week (Q4W) dosing: 36 of 54 patients in the study by Jadoul et al (41) and 55 of 161 patients in the study by Trachsler et al (40) Of these preselected patients, target Hb was maintained with oncemonthly dosing in 30 of 36 patients in the Jadoul study and 55 of 55 patients in the Trachsler study. However, these patients were previously stabilized on more frequent dosing intervals.…”

Section: Efficient Esa Administration Schedulesmentioning

confidence: 99%

Bundled-Rate Legislation for Medicare Reimbursement for Dialysis Services

Charytan¹

2010

Clinical Journal of the American Society of Nephrology

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With the incidence of ESRD on the rise, there is a continuing need to control anemia-related treatment costs in dialysis patients receiving reimbursement through Medicare. Currently, erythropoiesis-stimulating agents (ESAs) are billed separately from dialysis services, potentially creating little financial incentive for more efficient use. The Medicare Improvement for Patients and Providers Act, passed by the U.S. Congress in July 2008, includes provisions intended to address this concern. Under this act, dialysis services will be reimbursed using a fully bundled, comprehensive payment system that includes all services currently covered in the basic composite rate, as well as certain separately billable items, including ESAs. A base rate of $229.63 per treatment has been assigned, to be individualized using case-mix adjusters. The implications of this new system for anemia management with ESAs continue to be elucidated. With fixed compensation for ESAs, management strategies that maximize efficiencies and, thereby, optimize cost savings will be favored. Select strategies may include switching from intravenous (IV) to subcutaneous routes, lowering Hb targets and ESA doses in hyporesponsive patients, increasing administration of IV iron, increasing use of home dialysis, and optimizing ESA dosing intervals. Once-monthly ESA therapy has potential advantages under this new system as an alternative to more frequently administered ESAs and may help achieve quality metrics in a cost-efficient manner.

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Simplifying anemia management in hemodialysis patients: ESAs administered at longer dosing intervals can enhance opportunities to provide patient-focused care

Schiller

Besarab

2011

Current Medical Research and Opinion

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A fragmented, uncoordinated care-delivery model heightens the urgency to systematically address issues related to delivery of care and improve efficiencies in anemia management as part of the patient-centered approach. ESAs designed for administration at longer intervals may effectively and reliably achieve Hb targets with once-monthly dosing, thereby decreasing time spent administering/monitoring therapy.

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Parameters for successful monthly extended dosing of darbepoetin-alpha in patients undergoing hemodialysis

Abstract: Conversion to extended darbepoetin-alpha dosing intervals of up to QM, with maintenance of initial Hb concentrations, was successful for the majority of stable dialysis patients.

Cited by 3 publications

References 0 publications

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

Cost-effectiveness of continuous erythropoietin receptor activator in anemia

Bundled-Rate Legislation for Medicare Reimbursement for Dialysis Services

Simplifying anemia management in hemodialysis patients: ESAs administered at longer dosing intervals can enhance opportunities to provide patient-focused care

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