Time spent on erythropoietin stimulating agents administration in hemodialysis centers in Panama: a time and motion study.

Objectives: There is a lack of data in Panama on the potential differences in total healthcare professional (HCP) time between routine administrations of short-acting erythropoietin simulating agents (ESAs) (i.e. epoetin alfa) and continuous erythropoietin receptor activator (CERA) (i.e. methoxy polyethylene glycol-epoetin beta). This study aimed to quantify the HCP time associated with a single administration of epoetin alfa and CERA for the treatment of anemic patients with chronic kidney disease (CKD) on hemodialysis. Methods: This was a multi-center, cross-sectional study, using a time-and-motion methodology. Costs related to HCP time and consumables usage associated with administration of epoetin alfa and CERA were estimated. Results: Based on 60 administrations of either CERA or epoetin alfa, the estimated savings in mean total active HCP time were 2.34 (95% confidence interval = 1.87-2.81) min (-30%) per administration. When extrapolating to a full year's treatment with intravenous ESA, it would require a total of 20.3 (95% CI = 19.90-20.71) h of HCP time for epoetin alfa vs 1.1 (95% CI = 1.01-1.19) h for CERA per patient per year. Estimated savings in active HCP time per patient per year were 19.20 (95% CI = 19.20-19.21) h (-95%). This, in turn, translates into staff cost efficiency that favors Mircera with an estimated annual saving of $78.24 (95% CI = 78.24-78.28) (-95%) per patient. Conclusions: Data from a real-world setting showed that the adoption of CERA could potentially lead to a reduction in active HCP time. Highlights Few comparative data have explored the costs and potential savings of using long-acting erythropoietin-stimulating agents (ESA) instead of short-acting ESAs to treat anemia in CKD patients on hemodialysis. This time-and-motion study shows that use of CERA reduces total healthcare professional time and could represent a save for an institution in a real-world setting in Panama.

Uso de hierro intravenoso en pacientes renales crónicos con anemia. Mayores niveles de hemoglobina a más bajo costo / Use of intravenous iron in chronic renal patients with anemia. Higher levels of hemoglobin at a lower cost

It is presented the experience with 90 patients receiving Eritropoietin s.c. and oral iron who were in chronic haemodialysis. After basic laboratories, including iron kinetic, in all of them was stopped oral iron and started i.v. iron 60 mgs per week, but keeping the same eritropoietin doses. The results showed an increased haemoglobin level from 6.5 to 11 g/dl mean values and a decreased doses of eritropoietin between 25 to 50%. This represent an important elevation of haemoglobin levels at a significant low cost

[Use of intravenous iron in chronic renal patients with anemia. Higher levels of hemoglobin at a lower cost]. / Uso de hierro intravenoso en pacientes renales crónicos con anemia. Mayores niveles de hemoglobina a más bajo costo.

It is presented the experience with 90 patients receiving Eritropoietin s.c. and oral iron who were in chronic haemodialysis. After basic laboratories, including iron kinetic, in all of them was stopped oral iron and started i.v. iron 60 mgs per week, but keeping the same eritropoietin doses. The results showed an increased haemoglobin level from 6.5 to 11 g/dl mean values and a decreased doses of eritropoietin between 25 to 50%. This represent an important elevation of haemoglobin levels at a significant low cost.

Efficacy and cost analysis of treating very low birth weight infants with erythropoietin during their first two weeks of life: a randomized, placebo-controlled trial.

OBJECTIVE: We hypothesized that using a higher dose of erythropoietin (Epo) and starting treatment on the first day of life would reduce the transfusion requirements of ventilator-dependent and non-ventilator-dependent very low birth weight (VLBW) infants. Moreover, we hypothesized that this treatment would be cost-effective. METHODS: We randomly assigned 20 ill newborn VLBW infants to receive either Epo (200 units/kg per day) or placebo during their first 2 weeks of life. The caregivers were unaware of the treatment assignments, and erythrocyte transfusions were administered according to hematocrit and signs of anemia. RESULTS: On day 1, reticulocyte counts and hematocrits were similar in the two groups. During the subsequent 2 weeks, reticulocyte counts of the placebo recipients fell significantly below those of the Epo recipients, but hematocrits in the two groups did not differ. More transfusions were received by the placebo recipients (mean = 1.4 per patient) than by the Epo recipients (mean = 0.2 per patient; p < 0.01). No adverse effects of Epo were noted, and the costs in the placebo group exceeded those in the Epo group. CONCLUSIONS: We conclude that administration of Epo to VLBW infants during the first 2 weeks of life results in fewer transfusions and is cost-effective.

Optimizing epoetin therapy in end-stage renal disease: the case for subcutaneous administration.

The effectiveness of various recombinant human erythropoietin (epoetin) administration routes and dosage schedules in patients on dialysis was studied. The mean dose required to achieve and maintain a hematocrit level between 33% and 40% is 225 U/kg/wk when administered intravenously (i.v.) in three divided doses. A once-weekly i.v. schedule requires a dose of 429 U/kg/wk to maintain the same target hematocrit. In contrast, the required epoetin dose is reduced by an average of 25% to 50% when administered via the subcutaneous (SC) route. Analysis of data from 25 dialysis centers shows that SC epoetin administration resulted in higher normalized responses than i.v. administration. The hematocrit response in patients at these centers was proportional to the weekly dose, with a greater slope in those centers using predominantly SC as compared with i.v. dosing. Cost analysis indicates that the use of SC dosing two or three times weekly at an average total weekly dose of 120 U/kg is effective for the treatment of anemia in most patients on dialysis.