Cost minimisation analysis for darbepoetin alpha vs epoetin alpha in chronic kidney disease patients on haemodialysis

Introduction

Multiple studies have shown that epoetin alpha (r-HuEpo) and darbepoetin alpha (NESP) are similarly effective and safe for maintaining haemoglobin levels in patients with chronic kidney disease (CKD). Nevertheless, there is some debate over their cost-effectiveness. The purpose of this study is to carry out a cost-minimisation analysis including a comparison of the costs to the hospital arising from treatment with r-HuEpo vs NESP.

Methods

Prospective observational study. We included CKD patients on haemodialysis with no iron, vitamin B12 or folate deficiencies, treated with stable doses of IV r-HuEpo. Follow-up was performed over three periods: the first during six months, maintaining prior treatment with r-HuEpo; the second for eight months, after changing to NESP, and the third, during the final eight months, following resuming r-HuEpo treatment. For converting both treatments, the conversion factor established on technical sheet 1:200 was used.

Results

Fifty five patients completed the study and were valid for analysis. Their mean age was 68.3 years, and 18 were women (35.3%). The mean weekly doses at the end of each period were 8,058.8 (SD 3,911.1) IU for the EPO 1 period, 39.4 (SD 21.6) mg for NESP and 7,882.4 (SD 4,594.1) IU for EPO 2. The weekly costs for each treatment showed significant differences between NESP and r-HuEpo: the cost of NESP was higher.

Conclusion

In our study, we found that r-HuEpo and NESP were similarly effective in patients with CKD on haemodialysis, but that there was a significant cost increase associated with NESP treatment.