Abstract
To compare erythropoiesis-stimulating agent (ESA) dosing patterns and costs in outpatients with chronic kidney disease (CKD) not on dialysis or with chemotherapy-induced anemia (CIA). Electronic records from the Premier Perspective Comparative Hospital Database (2006Q1-2009Q3) were analyzed to identify outpatients ≥18 years old treated with epoetin alfa (EPO) or darbepoetin alfa (DARB). Patients receiving renal dialysis or treated with both ESAs were excluded. CKD patients had ≥1 claim for CKD, no claim for cancer, and did not receive chemotherapy. CIA patients had ≥1 claim for cancer, received chemotherapy, and had no claim for CKD. The mean cumulative ESA dose was used to calculate costs, based on April 2010 wholesale acquisition costs (EPO: $15.15/1,000 Units, DARB: $4.96/mcg). A total of 11,012 CKD (EPO: 6,921; DARB: 4,091) and 5,590 CIA (EPO: 2,856; DARB: 2,734) outpatients were identified. EPO patients were slightly younger than DARB patients in the CKD group (years: 71.0 vs. 71.6; P=.0341) and of similar age in the CIA group (years: 62.2 vs. 62.7; P=.1316). The proportion of females was higher in CKD (EPO 62.2% vs. DARB 58.8%; P=.0003) and smaller in CIA (EPO 63.4% vs. DARB 67.0%; P=.0047). The mean treatment duration was slightly longer for EPO CKD patients (months: 3.6 vs. 3.4, P=.0004) and similar for CIA patients (months: 2.6 vs. 2.5; P=.1816). The mean cumulative dose was EPO 137,101 Units and DARB 533 mcg in CKD, and EPO 221,652 Units and DARB 933 mcg in CIA, yielding dose ratios of 257:1 and 238:1 (Units EPO:mcg DARB), respectively. Corresponding ESA costs were higher for DARB than for EPO in both populations (CKD: $2,644 vs. $2,077; CIA: $4,627 vs. $3,358). This analysis reported dose ratios of 257:1 and 238:1 in CKD and CIA outpatients, respectively. DARB price premiums of 27% for CKD and 38% for CIA patients were observed.
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