Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study

Abstract

Objective: To calculate the variable costs involved with the process of delivering erythropoiesis stimulating agents (ESA) in European dialysis practices.Methods: A conceptual model was developed to classify the processes and sub-processes followed in the pharmacy (ordering from supplier, receiving/storing/delivering ESA to the dialysis unit), dialysis unit (dose determination, ordering, receipt, registration, storage, administration, registration) and waste disposal unit. Time and material costs were recorded. Labour costs were derived from actual local wages while material costs came from the facilities’ accounting records. Activities associated with ESA administration were listed and each activity evaluated to determine if dosing frequency affected the amount of resources required.Results: A total of 21 centres in 8 European countries supplied data for 142 patients (mean) per hospital (range 42–648). Patients received various ESA regimens (thrice-weekly, twice-weekly, once-weekly, once every 2 weeks and once-monthly). Administering ESA every 2 weeks, the mean costs per patient per year for each process and the estimates of the percentage reduction in costs obtainable, respectively, were: pharmacy labour (€10.1, 39%); dialysis unit labour (€66.0, 65%); dialysis unit materials (€4.11, 61%) and waste unit materials (€0.43, 49%).Limitation: Impact on financial costs was not measured.Conclusion: ESA administration has quantifiable labour and material costs which are affected by dosing frequency.