Journal Information
Vol. 34. Issue 2.
Pages 68-75 (January 2010)
Vol. 34. Issue 2.
Pages 68-75 (January 2010)
Full text access
Cost minimisation analysis for darbepoetin alpha vs epoetin alpha in chronic kidney disease patients on haemodialysis
Análisis de minimización de costes de darbepoetina alfa frente a epoetina alfa en pacientes con insuficiencia renal crónica sometidos a hemodiálisis
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C. Cuesta Grueso
Corresponding author
grueso_cri@gva.es

Corresponding author.
, J.L. Poveda Andrés, J. Garcia Pellicer, E. Romá Sánchez
Servicio de Farmacia, Hospital Universitario La Fe, Valencia, Spain
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Article information
Abstract
Introduction

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.

Methods

Prospective observational study. We included CKD 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.

Results

Fifty five 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 EPO 1 period, 39.4 (SD 21.6) mg for NESP and 7,882.4 (SD 4,594.1) IU for EPO 2. The weekly costs for each treatment showed significant differences between NESP and r-HuEpo: the cost of NESP was higher.

Conclusion

In our study, we found that r-HuEpo and NESP were similarly effective in patients with CKD on haemodialysis, but that there was a significant cost increase associated with NESP treatment.

Keywords:
Epoetin alpha
Darbepoetin alpha
Cost minimisation analysis
Chronic kidney disease
Resumen
Introducción

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.

Métodos

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.

Resultados

Cincuenta y un 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 EPO 1, 39,4 (SD 21,6) mg para el NESP y 7.882,4 (SD 4.594,1) UI para el EPO 2. Los costes semanales de cada tratamiento muestran diferencias significativas entre NESP y r-HuEpo, siendo el coste de NESP superior.

Conclusión

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.

Palabras clave:
Epoetina alfa
Darbepoetina alfa
Análisis de minimización de costes
Insuficiencia renal crónica
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