Cost should be the principal determinant of choice of erythropoiesis-stimulating agent in chronic haemodialysis patients

Abstract

Background/aims: Erythropoiesis-stimulating agents (ESAs) are effective in the management of the anaemia of chronic kidney disease but add substantially to the treatment costs. We performed a comparison cross-sectional analysis of ESA prescribing in 4 dialysis centres in Northern Ireland.

Methods: The ESA prescription and current haemoglobin (Hb) concentration for all patients on haemodialysis (HD) treatment for at least 3 months was extracted from the renal data system.

Results: A total of 403 patients were analysed, 184 (46%) were prescribed epoetin beta and 219 (54%) darbepoetin alpha. The mean Hb concentrations for both agents were comparable overall (Hb = 11.4 and 11.7 g/dl, p = 0.13), and for subcutaneous (SC) and intravenous (IV) administration: epoetin beta 11.5 g/dl (n = 119) and 11.4 g/dl (n = 65) (p = 0.70), and darbepoetin alpha 11.8 g/dl (n = 39) and 11.6 g/dl (n = 180) (p = 0.49). The mean weekly dose was 7,941 units of epoetin beta with SC and 9,200 units with IV administration (p = 0.10), and 45 mug SC and 46 mug IV of darbepoetin alpha (p = 0.94). The weekly cost of achieving equivalent Hb levels was GBP 61.86 (EUR 90.57/USD 115.68) with SC and GBP 71.67 (EUR 104.93/USD 134.02) with IV epoetin beta, and GBP 70.78 (EUR 103.63/USD 132.36) with SC and GBP 72.18 (EUR 105.68/USD 134.98) with IV darbepoetin alpha.

Conclusions: Epoetin beta and darbepoetin alpha are equally effective ESAs and the choice of ESA prescribed in stable HD patients should be determined by cost.