Bangkok, Thailand - Most patients receiving hemodialysis (HD) for end-stage renal disease (ESRD) currently receive erythropoietin (EPO) for anemia treatment. The goal of therapy is to achieve specific hemoglobin (Hb) target levels. Higher doses of EPO are used to attain higher target levels, but the appropriate Hb level is still controversial. Target Hb levels in chronic kidney disease (CKD) remain uncertain because Hb target levels above 13 g/dl have been associated with both benefit (quality of life) and harm (cardiovascular events).
Researchers from the Faculty of Pharmaceutical Science at Chulalongkorn University and the Faculty of Medicine at Siriraj Hospital, Mahidol University in Thailand compared the cost utility of using EPO to maintain different Hb target levels in hemodialysis patients from a societal perspective. The results of the study, “Cost Utility Analysis of Erythropoietin for Anemia Treatment in Thai ESRD Patients with Hemodialysis,” show that the incremental cost-effectiveness ratios of Hb levels of more than 9 to 10, > 10 to 11, > 11 to 12, and >12 g/dl compared with the least costly option (Hb> 9 g/dl) were US$24,128.03, US$18,789.07, US$22,427.36, and US$28,022.33 per quality-adjusted life-year, respectively. For the Thai hemodialysis patient, providing EPO for a hemoglobin level of more than 10 to 11 g/dl was more cost-effective than other hemoglobin levels.
“Erythropoietin is an expensive therapy and it has created an economic burden on the health care system of Thailand. Erythropoietin is essential for hemodialysis patients, but the appropriate Hb level is still uncertain. Thus, the decision to treat anemia in hemodialysis patients depends on the best practice guidelines that physicians rely on. In order to convince physicians or policy makers to take action for the appropriate Hb level, they need strong evidence-based research on the most cost-effective Hb level,” says Dr. Tanita Thaweethamcharoen, MPharm, PhD, Pharmacist and Health Economist at the Siriraj Hospital Health Policy Unit at Mahidol University in Bangkok, Thailand.
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