Cost-effectiveness of Treating Chronic Anemia with Epoetin Alfa among Hemodialysis Patients in the United States

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• 作者：Peter Quon ; MPH^a ; Matthew Gitlin ; PharmD^b ; John J. Isitt ; MS^b ; Sumit Mohan ; MD^c ; William M. McClellan ; MD ; MPH^d ; Jill Javier ; BS^a ; Gregory de Lissovoy ; PhD ; MPH^e ; Christopher S. Hollenbeak ; PhD^f ; ^{chollenbeak@psu.edu}
• 关键词：Anemia ; Erythropoiesis-stimulating agent ; Hemodialysis ; Hemoglobin ; Iron
• 刊名：Health Outcomes Research in Medicine
• 出版年：2012
• 期刊代码：pca177_18771319
• 类别：med
• 出版时间：May, 2012
• 卷：3
• 期：2
• 页码：e79-e89
• 文件大小：494 K

摘要

ass="h4">Objectives

The objectives of this analysis were to assess health and economic consequences of targeting hemoglobin (Hb) levels around 10-11 g/dL relative to 9-10 g/dL using an economic model and to explore the impact of different assumptions on cost-effectiveness.

ass="h4">Study Design

Clinical and economic impact of treating anemia in the US hemodialysis population to target Hb levels of 10-11 g/dL and 9-10 g/dL was assessed using a Markov model. A sensitivity analysis assessed the effects of varying assumptions on the model.

ass="h4">Results

Our cost-effectiveness analysis suggests that maintaining Hb 10-11 g/dL would result in average reductions of 0.51 hospitalizations and increases of 0.09 quality-adjusted life years per patient, with hospitalization cost offsets of $15,340 over 5 years when compared with Hb of 9-10 g/dL. Over the lifetime of the patient, cost-effectiveness improved with hospitalization cost offsets of $21,450 and increases of 0.12 quality-adjusted life years. Sensitivity analysis of individual parameters showed that mortality, hospitalization, health preference, and time horizon of the model had the most influence on cost-effectiveness.

ass="h4">Conclusions

Our analysis suggests that epoetin alfa use targeting Hb levels of 10-11 g/dL relative to 9-10 g/dL may result in better patient outcomes and lower costs. The sensitivity analysis highlighted how assumptions affected cost-effectiveness conclusions; the appropriateness of these assumptions will remain uncertain until new research in today鈥檚 dialysis population examining the effects of targeting to lower Hb levels is conducted.