Evaluation of dosages and costs associated with the use of erythropoietin receptor agonists in the treatment of anemia in patients with chronic kidney disease: the Local Health Unit of Alessandria experience

Abstract

Anemia represents one of the most frequent and debilitating disease associated with chronic kidney disease (CKD). If anemia is untreated, the quality of life is reduced and survival shortened. Epoetin (α o β) and darbepoetin-α 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-size (about 450,000 beneficiaries) Local Health Unit in Northern Italy. A sample was built by selecting all patients who, between 2007 and 2008, had a diagnosis of CKD and received at least two prescriptions for ERA. The study evaluated the durations of treatments, the RDDs (Received Daily Doses), the Dose Conversion Ratio (DCR) between epoetin (α o β) and darbepoetin-α, and the weekly costs associated with either treatment. The original sample consisted of 378 patients (mean age: 75.04 years, 51.9% males). The mean duration of treatment was 24.97 weeks for epoetin (α o β) and 25.12 weeks for darbepoetin-α (p = 0.92). The mean weighted relative RDD was 3.28 µg for darbepoetin-α (mean weekly dosage: 22.99 µg) and 601.14 IU for epoetin (α o β) [mean weekly dosage: 4,207.99 IU], with a DCR between epoetin (α o β) and darbepoetin-α of 183.01 IU: 1 µg. The weekly mean cost of treatment was €37.52 for patients treated with epoetin (α o β) and €48.07 for patients treated with darbepoetin-α (p = 0.003). Based on data from the Local Health Unit of Alessandria, we performed an analysis focused on the use of ERAs in the treatment of anemia in patients with CKD. The weekly mean cost of treatment and the DCR between epoetin (α o β) and darbepoetin-α resulted was consistent with a previous national study of drug utilization. Epoetin (α o β) is a cost-saving strategy compared with darbepoetin-α in the treatment of anemia in patients with chronic kidney disease.