Analisi dei consumi e dei costi degli agenti stimolanti l’eritropoiesi nel trattamento dell’anemia nei pazienti con insufficienza renale cronica

Abstract

During the maintenance dialysis as well the pre-dialysis period anemia represents one of the most frequent and debilitating diseases associated with chronic kidney disease (CKD). If anemia is untreated, the quality of life is reduced and survival is shortened. Epoetin and darbepoetin alfa are Erythropoietin Receptor Agonists (ERAs) indicated for the treatment of anemia in patients with CKD. Data for this retrospective study were derived from the administrative database of a middle-sized (half a million beneficiaries) Local Health Unit in Northern Italy. A sample was built by selecting all patients who, between 2005 and 2006, had a diagnosis of CKD and had received at least two prescriptions for ERAs. The study evaluated the durations of treatments, the RDDs (Received Daily Doses), the DCR (Dose Conversion Ratio) between epoetin and darbepoetin alfa, and the weekly costs associated with either treatment. The original sample consisted of 415 patients (mean age: 72.9 years, 53.7% males). The mean duration of treatment was 25.29 weeks for epoetin and 22.72 weeks for darbepoetin alfa (p = 0.02). The weighted relative mean RDD was 3.72 µg for darbepoetin alfa (weekly mean dosage: 26.04 µg) and 572.57 IU for epoetin (weekly dosage mean: 4008.00 IU), with a DCR between epoetin and darbepoetin alfa of 153.94 IU: 1 µg. The weekly mean cost of treatment was € 43.40 for patients treated with epoetin and € 72.36 for patients treated with darbepoetin alfa (p < 0.001). Administrative databases increasingly represent an important data source to conduct drug utilization studies. Based on data from a Local Health Unit, we performed an analysis focused on the use of ERAs in the treatment of anemia in patients with chronic kidney disease. The analysis results were interesting, particularly as attempt to estimate the DCR between epoetin and darbepoetin alfa (153.94 IU: 1 µg), which resulted consistent with other European studies. This evaluation showed that epoetin is a cost-saving strategy compared with darbepoetin alfa in the treatment of anemia in patients with chronic kidney disease. An important limitation was that patient records had not a severity of disease indicator. Probably the presence of a severity disease indicator might have helped to capture more clearly the analysis results.