Cost-Effectiveness of Treatments for Anemia in CKD

Boston—For patients with chronic kidney disease (CKD) with anemia, clinical guidelines recommend erythropoietin-stimulating agents (ESA), oral or intravenous (IV) iron, or red blood cell transfusions. The treatment recommendations depend on hemoglobin level and prior treatment. The economic implications of the treatment decisions are uncertain.

Tara Lavelle, PhD, and colleagues recently conducted a review of published cost-effective analyses to improve understanding of study methods and results used in those models. Results of the review were reported during a poster session at the NKF Spring Clinical Meetings in a poster titled A Review of Cost-Effectiveness Analyses for Anemia in Chronic Kidney Disease.

The search included the TUFTS cost-effectiveness analysis (CEA) registry, Medline, and EMBASE, as well as conference abstract libraries for CEAs specific to CKD anemia published between January 2000, and May 2018. Keywords specific to anemia, CKD, and CEA were searched. Predefined eligibility criteria were used to screen studies; relevant data were abstracted from eligible studies.

A total of 128 studies were identified; of those, eight met eligibility criteria. Half were CEAs of pharmacotherapies (eg, ESA vs no ESA, oral vs IV iron) and half examined modified approaches for healthcare delivery (eg, specialist-managed care). In five CEAS, Markov models were used, and three were piggyback cost analyses (two on clinical trials and one on cohort studies). Time horizons varied from 5 weeks to a lifetime, countries were mostly United States and Canada (three each), and two reported results from the societal perspective. Seven of the eight CEAs incorporated sensitivity analyses (one-way and/or probabilistic).

In five CEAs, the study population included dialysis-dependent patients, including one that demonstrated IV iron was cost-effective compared with oral iron, particularly in patients <45 years of age. Two CEAs compared ESA to red blood cell transfusion; results demonstrated that ESA was cost-effective in a 10-year model but not over a lifetime in a Canadian model. However, the Canadian model did show improvement in cost-effectiveness  with the use of lower hemoglobin targets (9-11 vs >12 g/dL). Two CEAs found that specialist-managed care by a nephrologist or pharmacist was cost-effective compared with standard care for non–dialysis-dependent patients.

In summary, the researchers said, “Few CEAs have been published in CKD anemia, and between-study variability exists, contributing to discrepant results. Research teams can leverage these review findings when considering different approaches for new CEAs that will help stakeholders better understand the economic implications of treatment decisions for CKD anemia in today’s healthcare system.”

Source: Lavelle T, Michalopoulos S, Margaretos N, et al. A review of cost-effectiveness analyses for anemia in chronic kidney disease. Abstract of a poster presented during the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.