Underutilization of peritoneal dialysis: the role of the nephrologist's referral pattern

Hingwala, Jay; Diamond, Jeff; Tangri, Navdeep; Bueti, Joe; Rigatto, Claudio; Sood, Manish M.; Verrelli, Mauro; Komenda, Paul

doi:10.1093/ndt/gfs323

Cited by 26 publications

(26 citation statements)

References 41 publications

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“…Patient demographics were not collected, but previous studies of our HD population in the Manitoba Renal Program suggest consistent demographics and we would not anticipate these would differ between the two time periods of this study [28,29,30]. We did not collect information on other important factors that would be expected to influence epoetin α dosing, including concurrent medical conditions, bleeding episodes, blood transfusions, iron studies or infections.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of an Intravenous to Subcutaneous Epoetin α Conversion

et al. 2013

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Background/Aims: A cost analysis of a conversion from intravenous (IV) to subcutaneous (SC) epoetin α in patients receiving chronic in-center hemodialysis (HD). Methods: This retrospective analysis compared epoetin α drug costs during a 6-month period of IV usage (July to December 2010, period 1) to a 6-month period of SC usage (July to December 2011, period 2) in four large in-center HD units. Data were collected from quarterly counts of HD patients receiving epoetin α and monthly inventory billing records. Results: 622 HD patients who received IV epoetin α (period 1) were compared to 609 HD patients who received SC epoetin α (period 2). A 12.6% decrease in dose was observed. The average weekly cost of epoetin α was USD 173.02 per patient during the IV period versus USD 151.20 per patient during the SC period. This equated to a yearly cost savings of USD 1,135 per patient with SC epoetin α. Conclusion: The switch from IV to SC epoetin α was successfully implemented in all four centers and realized significant cost savings.

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Section: Discussionmentioning

confidence: 99%

Cost Analysis of an Intravenous to Subcutaneous Epoetin α Conversion

et al. 2013

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“…Physician's attitudes appear to be highly influential in renal replacement therapy modality decisions. A study in a regional Canadian renal program determined that the individual patient nephrologist was a major variable influencing the rate of peritoneal dialysis uptake across sites, even after adjustment for comorbid conditions and site differences [33]. Interestingly, patients seen by nephrologists with a more aggressive approach to peritoneal dialysis assignment did not experience higher rates of mortality or technique failure.…”

Section: Peritoneal Dialysismentioning

confidence: 99%

Cost-effective treatment modalities for reducing morbidity associated with chronic kidney disease

Ferguson

Tangri

Rigatto

et al. 2015

Expert Review of Pharmacoeconomics & Outcomes Research

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Chronic kidney disease (CKD) is a worldwide health problem with increasing prevalence and incidence. Guidelines suggest that early referral to a nephrologist to manage advanced stage (4+) patients with CKD is an effective treatment strategy, with earlier stage patients best managed through primary care physicians. Should patients with CKD progress to total kidney failure, several therapies are available that vary widely in costs. Kidney transplantation offers the lowest costs and highest quality of life, followed in ascending order of costs by peritoneal dialysis, home hemodialysis and facility-based hemodialysis. Earlier detection of CKD may prevent progression to kidney failure, and accurate risk prediction of end-stage kidney failure may improve clinical planning, outcomes and resource allocation.

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“…It ought to be reminded that observers obtain the so called efficacy in the course of preclinical and clinical studies; this efficacy is specified for MT registration; doctors obtain effectiveness in the course of clinical practice [1]. The situation when data on MT efficacy do not translate into data on effectiveness is described in the foreign literature as "lost in translation" [2][3][4]. Several authors suggest resolving this issue radically by introducing a 10-year-long moratorium on, for instance, registration clinical studies [5].…”

Section: Relevancementioning

confidence: 99%