Probabilistic cost-minimisation analysis of darbepoetin alpha versus epoetin alpha in treating anaemia secondary to chronic renal failure. Assessment in Spanish clinical practice

Sanz-Granda, A.

doi:10.1016/S2173-5085(09)70086-3

Article information

Abstract

Introduction

The direct transfer of the results of pharmaco-economic studies between countries may not be suitable if the proper adaptations are not made to take into account differences in treatment patterns, resource use, and costs from country to country.

Objective

To estimate the cost in Spain of treating anaemia secondary to chronic renal failure with darbepoetin alpha or epoetin alpha from a review and analysis of available current information. In addition, the role of the route of administration as a main driver of the cost will be analysed.

Method

Population: patients with chronic renal failure induced anaemia. Data: Medline and Embase search of studies directly comparing erythropoiesis stimulating agents. Analysis: Cost minimization analysis from the perspective of a hospital pharmacy department. The main outcome chosen was the difference between the average cost per patient undergoing a 30-day treatment with epoetin alpha versus darbepoetin alpha.

Results

a) Haemodialysis: changing from epoetin alpha to darbepoetin alpha is associated with a cost reduction of 8.67%; 95% CI, −1.34 to 17.92 (€uro17.48; 95% CI, −2.70 to 36.13); probabilistic analysis showed that the use of darbepoetin alpha could be associated with a costsaving probability of 94.9%. The IV administration yielded a decrease in costs of about 16.00%; 95% CI, −2.38 to 36.77 (€uro41.78, 95% CI: −6.21 to 96.04); b) Pre-dialysis: darbepoetin alpha is associated with a cost reduction of about 11%–32%.

Conclusions

The use of darbepoetin alpha for the treatment of chronic renal failure induced anaemia (haemodialysis and pre-dialysis) shows higher cost efficiency than epoetin alpha in Spain; these differences increase with IV administration.

Keywords:

Darbepoetin alpha

Epoetin alpha

Anaemia

Chronic renal failure

Cost minimisation

Probabilistic model

Resumen

Introducción

La transferencia directa de los resultados de estudios farmacoeconómicos de un país a otro no es adecuada si no se procede previamente a una adaptación de los datos a cada territorio, debido a la diversidad de utilización de recursos así como a las diferencias de costes entre países.

Objetivo

Estimar el coste en España del tratamiento de la anemia secundaria a insuficiencia renal crónica con epoetina alfa o darbepoetin alfa, a partir de una revisión y un análisis de la información actualmente disponible. Además, se analiza el papel de la vía de administración como factor modulador del coste del tratamiento.

Método

Población: pacientes con anemia secundaria a insuficiencia renal crónica. Extracción de datos: búsqueda en Medline y Embase de estudios de comparación directa de los agentes estimulantes de eritropoyesis. Tipo de análisis: análisis probabilístico de minimización de costes. Perspectiva: servicio de farmacia del hospital (costes farmacológicos). Variable principal: diferencia del coste medio por paciente del tratamiento de 30 días con epoetina alfa respecto de darbepoetin alfa.

Resultados

a) Hemodiálisis: la sustitución de epoetina alfa por darbepoetin alfa se asocia a una reducción mensual de costes del 8,67%; intervalo de confianza (IC) del 95%, −1,34 a 17,92 (17,48 €; IC del 95%, −1,38 a 36,13); el análisis probabilístico mostró una probabilidad del 94,9% de que la utilización de darbepoetin alfa estuviera asociada a una reducción del coste. Mediante la administración por vía intravenosa, la disminución es del 16,00%; IC del 95%, −2,38 a 36,77 (41,78 €; IC del 95%, −6,21 a 96,04). b) Prediálisis: la reducción de costes con darbe- poetin alfa se sitúa en el rango más probable del 11–32%.

Conclusiones

La utilización en España de darbepoetin alfa en el tratamiento de la anemia secundaria a insuficiencia renal crónica (hemodiálisis y prediálisis) presenta una eficiencia superior a la estimada con epoetina alfa; esta diferencia en costes aumenta con la administración por vía intravenosa.

Palabras clave:

Darbepoetina alfa

Epoetina alfa

Anemia

Insuficiencia renal crónica

Minimización de costes

Modelo probabilístico

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