Cost Should Be the Principal Determinant of Choice of Erythropoiesis-Stimulating Agent in Chronic Haemodialysis Patients

Background/Aims: Erythropoiesis-stimulating agents (ESAs) are effective in the management of the anaemia of chronic kidney disease but add substantially to the treatment costs. We performed a comparison cross-sectional analysis of ESA prescribing in 4 dialysis centres in Northern Ireland. Methods: The ESA prescription and current haemoglobin (Hb) concentration for all patients on haemodialysis (HD) treatment for at least 3 months was extracted from the renal data system. Results: A total of 403 patients were analysed, 184 (46%) were prescribed epoetin β and 219 (54%) darbepoetin α. The mean Hb concentrations for both agents were comparable overall (Hb = 11.4 and 11.7 g/dl, p = 0.13), and for subcutaneous (SC) and intravenous (IV) administration: epoetin β 11.5 g/dl (n = 119) and 11.4 g/dl (n = 65) (p = 0.70), and darbepoetin α 11.8 g/dl (n = 39) and 11.6 g/dl (n = 180) (p = 0.49). The mean weekly dose was 7,941 units of epoetin β with SC and 9,200 units with IV administration (p = 0.10), and 45 µg SC and 46 µg IV of darbepoetin α (p = 0.94). The weekly cost of achieving equivalent Hb levels was GBP 61.86 (EUR 90.57/USD 115.68) with SC and GBP 71.67 (EUR 104.93/USD 134.02) with IV epoetin β, and GBP 70.78 (EUR 103.63/USD 132.36) with SC and GBP 72.18 (EUR 105.68/USD 134.98) with IV darbepoetin α. Conclusions: Epoetin β and darbepoetin α are equally effective ESAs and the choice of ESA prescribed in stable HD patients should be determined by cost.

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