Duh Mei Sheng, Mody Samir H, Scott McKenzie R, Lefebvre Patrick, Gosselin Antoine, Tak Piech Catherine
Analysis Group, Inc., Boston, Massachusetts 02199, USA.
Clin Ther. 2006 Sep;28(9):1443-50. doi: 10.1016/j.clinthera.2006.09.020.
Epoetin alfa (EPO) and darbepoetin alfa (DARB) are erythropoietic agents indicated in the United States for the treatment of anemia in chronic kidney disease (CKD).
This study investigated dosing patterns and costs associated with the use of erythropoietic-stimulating therapy (EST) in patients with CKD not on dialysis who were newly starting EPO or DARB therapy in managed care organizations.
This was a retrospective analysis of medical claims data from >30 health plans for the period from July 2002 to February 2005. Patients were included if they were aged > or =18 years, had > or =1 claim for CKD within 90 days before the initiation of treatment, had newly started therapy with EPO or DARB, and had received > or =2 doses of treatment. If a patient was undergoing renal dialysis, data were censored 30 days before the first date of dialysis. Patients with a diagnosis of cancer or who had undergone chemotherapy were excluded from the analysis. The mean dosing interval was determined for both groups. Mean weekly doses and costs (using 2005 wholesale acquisition costs), weighted by the treatment duration, were calculated. The frequency of outpatient nephrologist visits was described and included in cost considerations.
The study population consisted of 595 patients who received EPO and 260 who received DARB. The EPO group was significantly older than the DARB group (mean age, 63.5 vs 61.2 years, respectively; P = 0.020). The proportion of women was similar between the 2 groups (51.6% and 50.4%). Use of extended dosing (> or =q2wk) was common in both groups (63.2% and 90.8%). The weighted mean weekly dose was 11,536 U for EPO and 42.5 mug for DARB. The mean number of outpatient nephrologist visits during treatment was similar between the 2 groups (3.9 and 3.5). Mean weekly costs (EST drug cost plus cost of nephrologist visits) were significantly lower for EPO compared with DARB (159 dollars vs 205 dollars; P < 0.001).
The majority of these CKD patients newly started on EST in managed care organizations received extended dosing regimens (> or =q2wk) of EPO or DARB. EPO treatment was associated with significantly lower mean weekly costs compared with DARB. The number of outpatient nephrology visits did not differ significantly between groups.
促红细胞生成素α（EPO）和 darbepoetin alfa（DARB）是在美国被批准用于治疗慢性肾脏病（CKD）贫血的促红细胞生成剂。
本研究调查了在管理式医疗组织中开始新的 EPO 或 DARB 治疗的非透析 CKD 患者使用促红细胞生成刺激疗法（EST）的给药模式和成本。
这是一项对 2002 年 7 月至 2005 年 2 月期间 30 多个健康计划的医疗理赔数据的回顾性分析。纳入标准为年龄≥18 岁、在开始治疗前 90 天内有≥1 次 CKD 理赔记录、新开始 EPO 或 DARB 治疗且接受≥2 次治疗剂量。如果患者正在接受肾脏透析，则在首次透析日期前 30 天截断数据。诊断为癌症或接受过化疗的患者被排除在分析之外。确定两组的平均给药间隔。计算平均每周剂量和成本（使用 2005 年批发采购成本），并根据治疗持续时间进行加权。描述门诊肾病专家就诊频率并纳入成本考量。
研究人群包括 595 例接受 EPO 治疗的患者和 260 例接受 DARB 治疗的患者。EPO 组的年龄显著大于 DARB 组（平均年龄分别为 63.5 岁和 61.2 岁；P = 0.020）。两组女性比例相似（分别为 51.6%和 50.4%）。两组中延长给药（≥每 2 周 1 次）的使用都很常见（分别为 63.2%和 90.8%）。EPO 的加权平均每周剂量为 11,536 U，DARB 为 42.5 μg。两组治疗期间门诊肾病专家就诊的平均次数相似（分别为 3.9 次和 3.5 次）。与 DARB 相比，EPO 的平均每周成本（EST 药物成本加肾病专家就诊成本）显著更低（159 美元对 205 美元；P < 0.001）。
在管理式医疗组织中开始新的 EST 治疗的这些 CKD 患者中，大多数接受了 EPO 或 DARB 的延长给药方案（≥每 2 周 1 次）。与 DARB 相比，EPO 治疗的平均每周成本显著更低。两组门诊肾病就诊次数无显著差异。
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