Abstract
Diversos estudios han demostrado similar efectividad y seguridad de epoetina alfa (r-HuEpo) y darbepoetina alfa (NESP) en el mantenimiento de los niveles de hemoglobina, en pacientes con insuficiencia renal crónica (IRC). Sin embargo, existe controversia en cuanto a su eficiencia. El objetivo de este estudio es la realización de un análisis de minimización de costes (AMC), y como parte del mismo se comparan los costes que supone para el hospital el tratamiento con r-HuEpo frente a NESP. Estudio observacional prospectivo. Se incluyeron pacientes con IRC sometidos a hemodiálisis, sin déficit de hierro, vitamina B12 o folato, tratados con r-HuEpo IV a dosis estables. El seguimiento se realizó en 3 periodos: el primero durante 6 meses, manteniendo la terapia previa con r-HuEPO, el segundo, de 8 meses, tras cambiar a NESP y el tercero, los últimos 8 meses tras nuevo cambio a r-HuEPO. Para la conversión de ambos tratamientos se utilizó el factor de conversión establecido en ficha técnica 1:200. 51 pacientes completaron el estudio y fueron válidos para el análisis, con una media de edad de 68,3 años, de los cuales 18 fueron mujeres (35,3%). Las dosis medias semanales al final de cada periodo fueron de 8.058,8 (SD 3.911,1) UI para el periodo EPO1, 39,4 (SD 21,6) μg para el NESP y 7.882,4 (SD 4.594,1) UI para el EPO2. Los costes semanales de cada tratamiento muestran diferencias significativas entre NESP y r-HuEpo, siendo el coste de NESP superior. En nuestro estudio encontramos una eficacia similar de r-HuEpo y NESP en pacientes con IRC sometidos a hemodiálisis, y un incremento significativo de los costes asociado al tratamiento con NESP. Multiple studies have shown that epoetin alpha (r-HuEpo) and darbepoetin alpha (NESP) are similarly effective and safe for maintaining haemoglobin levels in patients with chronic kidney disease (CKD). Nevertheless, there is some debate over their cost-effectiveness. The purpose of this study is to carry out a cost-minimisation analysis including a comparison of the costs to the hospital arising from treatment with r-HuEpo vs. NESP. Prospective observational study. We included CRF patients on haemodialysis with no iron, vitamin B12 or folate deficiencies, treated with stable doses of IV r-HuEpo. Follow-up was performed over three periods: the first during six months, maintaining prior treatment with r-HuEpo; the second for eight months, after changing to NESP, and the third, during the final eight months, following resuming r-HuEpo treatment. For converting both treatments, the conversion factor established on technical sheet 1:200 was used. 51 patients completed the study and were valid for analysis. Their mean age was 68.3 years, and 18 were women (35.3%). The mean weekly doses at the end of each period were 8,058.8 (SD 3,911.1) IU for the EPO1 period, 39.4 (SD 21.6) μg for NESP and 7,882.4 (SD 4,594.1) IU for EPO2. The weekly costs for each treatment showed significant differences between NESP and r-HuEpo: the cost of NESP was higher. In our study, we found that r-HuEpo and NESP were similarly effective in patients with CRF on haemodialysis, but that there was a significant cost increase associated with NESP treatment.
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