Cinque anni di utilizzo degli agenti stimolanti l’eritropoiesi nella terapia dell’anemia indotta da insufficienza renale nell’ASL di Pavia

Abstract

Anemia is a frequent and highly debilitating condition associated with chronic kidney disease (CKD). Epoetin (alfa or beta) and darbepoetin alfa are erythropoietin receptor agonists (ERAs) indicated for the treatment of anemia in patients with CKD. Several studies demonstrated that ERAs are effective in the treatment of CKD-related anemia by increasing hemoglobin levels. To describe consumption and costs trends of ERAs in the Local Health Unit of Pavia during the period 2004–2008. We also calculated the number of patients treated with ERAs, the mean admnistration dose, the mean cost per standard unit, the dose conversion ratio (DCR) between epoetin and darbepoetin alfa and the mean cost per treated patient with epoetin or darbepoetin alfa. Data for this retrospective study were derived from the administrative database of the Local Health Unit of Pavia. A sample was built by selecting all patients who had a diagnosis of CKD and received at least one ERA prescription between 2004 and 2008. The study evaluated the annual pharmaceutical spending for ERAs. We also analysed the pharmaceutical spending in order to point out the possible presence of significant cost-drivers like number of patients, Received Daily Dose or cost per μg/IU. We calculated the DCR between epoetin and darbepoetin alfa and their annual mean treatment costs. The number of patients and the pharmaceutical spending for the treatment of CKD with ERAs increased systematically in the five-year period (10% and 12.7% annually, respectively). The number of patients is the most important cost-driver in order to explain the increase of pharmaceutical spending. The mean five-year period DCR between epoetin (alfa or beta) and darbepoetin alfa is 179.10 IU: 1 μg. The annual mean cost of treatment was €1,334.57 for patients treated with epoetin and €1,802.78 for patients treated with darbepoetin alfa. The number of patients is the most important cost-driver which explains the growth of ERA consumption during the period 2004–2008. Over this five-year period, epoetin (alfa or beta) was a cost-saving strategy compared to darbepoetin alfa in the treatment of anemia in patients with CKD.