Erythropoiesis-stimulating agents for anemia of chronic kidney disease: systematic review and economic evaluation
Tonelli M, Klarenbach S, Wiebe N, Shrive F, Hemmelgarn B, Manns B
Record ID 32008000111
English, French
Authors' objectives:
"The aim of this review was to assess the evidence for clinical efficacy and harms and the economic implications of ESA use in adult patients with anemia of CKD." (executive summary)
Authors' recommendations:
In an environment where decision makers are willing to reimburse ESA, our base case analysis suggests that treatment to a target Hb of 110 g/L is most likely to be cost-effective. This strategy, however, will lead to higher costs (mainly due to ESA acquisition) compared to the low Hb target strategy, and it is based on the assumption that the intermediate target will improve QoL compared with the low target, which is unproven. Given the generally modest clinical benefit of ESA and the direct relationship between dose and cost, it may be prudent to consider a maximum ESA dose (above which the dose would not be increased further, even if the Hb target were not reached). Future research should focus on this comparison. In the interim, decision makers might reasonably choose to reimburse only the low Hb strategy because of the uncertainty in the quality-of-life gains associated with the intermediate strategy. Because of the higher cost of IV epoetin, the merits of reimbursing only SC epoetin (or darbopoetin by either route) should be explored. Lastly, because even small differences in potency per unit cost of ESA can translate into large differences in total costs, head-tohead comparisons of epoetin and darbepoetin should be considered.
Authors' methods:
Systematic review
Details
Project Status:
Completed
Year Published:
2008
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Anemia
- Kidney Diseases
- Erythropoiesis
Contact
Organisation Name:
Canadian Agency for Drugs and Technologies in Health
Contact Address:
600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name:
requests@cadth.ca
Contact Email:
requests@cadth.ca
Copyright:
Canadian Agency for Drugs and Technologies in Health (CADTH)
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