Maddux Franklin W, Shetty Sharashchandra, del Aguila Michael A, Nelson Michael A, Murray Brian M
Specialty Care Services Group, Nashville, TN 37203, USA.
Ann Pharmacother. 2007 Nov;41(11):1761-9. doi: 10.1345/aph.1K194. Epub 2007 Sep 25.
Anemia commonly complicates chronic kidney disease (CKD). Treating anemia of CKD with erythropoiesis-stimulating agents (ESAs) may attenuate cardiovascular and renal sequelae, reducing morbidity, mortality, and healthcare costs.
To compare clinical outcomes, healthcare utilization, and costs in ESA-treated and untreated patients with anemia of CKD who are not on dialysis.
This retrospective claims analysis considered more than 13 million US health plan members for outpatient, inpatient, emergency department, and prescription experience. Eligible patients were aged 15 years or older with 2 or more ICD-9 diagnoses of CKD or 1 or more CKD diagnosis and 1 or more claims for ESA within 12 months. The first CKD diagnosis within the study period (January 1, 2000-December 31, 2003) defined the index date. Anemia was ascertained by ICD-9 codes or ESA claims on or after the CKD index date. Patients were censored for dialysis, transplant, inpatient death, disenrollment, or study end. Utilization and costs per patient per month were compared between ESA and non-ESA patients. Generalized linear modeling identified predictors of total and anemia-related costs.
Of 26,244 patients with CKD, 8188 (31.2%) had anemia; of those, only 14.6% (n = 1197) received ESAs. ESA recipients had lower total monthly healthcare costs than did untreated anemic patients ($3876 vs $4758; p = 0.0061). Lower monthly inpatient and emergency department costs in treated versus untreated anemic patients ($2507 vs $3849 and $46.56 vs $81, respectively; both p < 0.0001) outweighed higher outpatient and laboratory costs from ESA use ($602 vs $397 and $23.50 vs $14.34, respectively; both p < 0.0001). Multivariate analysis revealed that ESA users had lower adjusted monthly total costs ($2962 vs $3373) compared with non-ESA patients.
ESA use was associated with mean total cost savings of $411 per patient per month, reflecting reduced inpatient and emergency department visits and costs, and with lower inpatient mortality and longer time to dialysis. The low (14.6%) ESA treatment rate for anemia highlights the continuing deficit in CKD care.
贫血是慢性肾脏病（CKD）常见的并发症。使用促红细胞生成素（ESA）治疗CKD患者的贫血可能会减轻心血管和肾脏后遗症，降低发病率、死亡率和医疗成本。
比较接受ESA治疗和未接受治疗的非透析CKD贫血患者的临床结局、医疗资源利用情况和成本。
这项回顾性索赔分析纳入了超过1300万美国健康计划成员，以了解其门诊、住院、急诊科和处方使用情况。符合条件的患者年龄在15岁及以上，有2次或更多次ICD-9诊断为CKD，或有1次或更多次CKD诊断且在12个月内有1次或更多次ESA索赔。研究期间（2000年1月1日至2003年12月31日）的首次CKD诊断定义为索引日期。通过CKD索引日期或之后的ICD-9编码或ESA索赔确定贫血情况。对接受透析、移植、住院死亡、退出研究或研究结束的患者进行截尾。比较ESA患者和非ESA患者每月的医疗资源利用情况和成本。广义线性模型确定了总费用和贫血相关费用的预测因素。
在26244例CKD患者中，8188例（31.2%）患有贫血；其中，只有14.6%（n = 1197）接受了ESA治疗。接受ESA治疗的患者每月总医疗成本低于未治疗的贫血患者（3876美元对4758美元；p = 0.0061）。与未治疗的贫血患者相比，接受治疗的贫血患者每月住院和急诊科成本较低（分别为2507美元对3849美元和46.56美元对81美元；p均<0.0001），这超过了因使用ESA导致的较高门诊和实验室成本（分别为602美元对397美元和23.50美元对14.34美元；p均<0.0001）。多变量分析显示，与非ESA患者相比，使用ESA的患者调整后的每月总成本较低（2962美元对3373美元）。
使用ESA与每位患者每月平均节省411美元的总成本相关，这反映了住院和急诊科就诊次数及成本的减少，以及住院死亡率的降低和开始透析时间的延长。贫血患者的ESA治疗率较低（14.6%），这突出了CKD治疗中持续存在的不足。
