The Cost-Effectiveness of Continuous Erythropoiesis Receptor Activator Once Monthly versus Epoetin Thrice Weekly for Anaemia Management in Chronic Haemodialysis Patients

Abstract

Introduction. The aim of this study was to compare the cost-effectiveness of continuous erythropoietin receptor activator (CERA) once monthly to epoetin beta (EpoB) thrice weekly to maintain haemoglobin (Hb) within the range 10.5-12 g/dL. Methods. Prospective cohort study and cost-effectiveness analysis. Chronic haemodialysis patients (CHP), being treated with EpoB, were selected for two periods of follow-up: period 1, maintaining prior treatment with EpoB, and period 2, conversion to CERA once monthly. Hb concentrations and costs were measured monthly. Health care payer perspective for one year was adopted. Results. 75 CHP completed the study, with a mean age of 52.9 ± 14.3 years. Baseline Hb was 11.14 ± 1.18 g/dL in EpoB phase and 11.46 ± 0.79 g/dL in CERA phase; we observed a significant increase in the proportion of patients successfully treated (Hb within the recommended range), 65.3% versus 70.7%, p: 0.008, and in the average effectiveness by 4% (0.55 versus 0.59). Average cost-effectiveness ratios were 6013.86 and 5173.64$, with an ICER CERA to EpoB at -6457.5$. Conclusion. Our health economic evaluation of ESA use in haemodialysis patients suggests that the use of CERA is cost-effective compared with EpoB.

Figure 1

Patients included in the study.

Figure 2

Evolution of mean Hb concentration during the two phases of the study. Hb: hemoglobin, EpoB recombinant human erythropoietin beta, CERA: continuous erythropoietin receptor activator, and CSR: clinical success rate (HB within the target 10,5–12 g/dL).

Figure 3

(a) Decision tree framework. (b) Results of cost-effectiveness analysis after roll-back calculation. EpoB: recombinant human erythropoietin beta, CERA: continuous erythropoietin receptor activator, CE ration: cost-effectiveness ratio.

Figure 4

Cost-effectiveness diagram. EpoB is dominated by CERA since it is more costly and less effective.

Figure 5

Results of Monte Carlo simulation of incremental cost and effectiveness scatter plot of CERA versus EpoB, based on 50000 random iterations of cost-effectiveness model.

Figure 6

Probabilistic sensitivity analysis of ICER distribution of CERA versus EpoB. The analysis confirmed the robustness of the model, based on 50 000 random iteration; the ICER remain within the range of calculated ICER ± 10%.