Cost implications to medicare of recombinant erythropoietin therapy for the anemia of end-stage renal disease

Neil R. Powe, Robert I. Griffiths, Eric B Bass

Research output: Contribution to journalArticle

Abstract

The purpose of this study was to estimate the net cost effect to Medicare of the increasing use of recombinant human erythropoietin (EPO) instead of red blood cell transfusions or androgens in the management of anemia for the approximately 100,000 hemodialysis patients in the U.S. End-Stage Renal Disease (ESRD) program. A computerized decision model that takes into account the effectiveness and possible side effects of transfusions, androgens, and EPO and predicts 1- and 5-yr direct medical costs to Medicare associated with each therapy was constructed. Probability estimates for clinical events were derived from the literature. Costs were assigned by use of the amounts Medicare pays providers of ESRD care for: (1) use of EPO, transfusions, and androgens; and (2) health care services related to the treatment of anemia (including complications of treatment and possible reductions in morbidity). For every 10,000 hemodialysis patients treated with EPO, net Medicare expenditures will be much greater than if only transfusions are used by $42,530,000 at 1 yr (6% of ESRD program costs) and by $118,050,000 at 5 yr and also much greater than if androgens are used (by $42,700,000 at 1 yr and $118,370,000 at 5 yr). The increase in cost was highly sensitive to the dose of EPO; moderately sensitive to changes in estimated anemia response rates for EPO, frequency of EPO-induced vascular access clotting, and reduction in cardiovascular or overall morbidity; and slightly sensitive to transfusion rates, estimated anemia response rates for androgens, frequency of EPO-induced seizure or hypertensive complications (stroke, myocardial infarction), frequency of transfusion-related viral infection, and frequency of androgen-induced virilization. Considering both effectiveness and side effects of alternative treatments for the anemia of ESRD, it was projected that the increasing use of EPO will markedly increase the cost to Medicare of ESRD medical care.

Original languageEnglish (US)
Pages (from-to)1660-1671
Number of pages12
JournalJournal of the American Society of Nephrology
Volume3
Issue number10
StatePublished - Apr 1993
Externally publishedYes

Fingerprint

Erythropoietin
Medicare
Chronic Kidney Failure
Anemia
Costs and Cost Analysis
Androgens
Therapeutics
Renal Dialysis
Morbidity
Virilism
Erythrocyte Transfusion
Cost of Illness
Virus Diseases
Health Expenditures
Computer Simulation
Health Services
Blood Vessels
Seizures
Stroke
Myocardial Infarction

Keywords

  • Anemia
  • Cost-benefit analysis
  • Economic analysis
  • Erythropoietin
  • ESRD
  • Medicare
  • Recombinant erythropoietin

ASJC Scopus subject areas

  • Nephrology

Cite this

Cost implications to medicare of recombinant erythropoietin therapy for the anemia of end-stage renal disease. / Powe, Neil R.; Griffiths, Robert I.; Bass, Eric B.

In: Journal of the American Society of Nephrology, Vol. 3, No. 10, 04.1993, p. 1660-1671.

Research output: Contribution to journalArticle

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