Utilization and cost comparison of erythropoiesis-stimulating agents in inpatient and outpatient hospital settings

Figures & data

Table 1.  Characteristics of patients with cancer chemotherapy or pre-dialysis chronic kidney disease receiving EPO vs DARB in inpatient settings.

	Cancer chemotherapy			Pre-dialysis chronic kidney disease
	EPO	DARB	p-value	EPO	DARB	p-value
	(n = 10,454)	(n = 3378)		(n = 116,017)	(n = 32,729)
Characteristics
Age, years, mean ± SD	60.7 (14.6)	59.2 (15.4)	<0.01	71.0 (14.2)	71.2 (14.2)	0.02
Female, n (%)	5531 (52.9)	1817 (53.8)	0.37	60,637 (52.3)	16,787 (51.3)	<0.01
Degree of illness severity,^a n (%)
Minor	570 (5.5)	168 (5.0)	<0.01	876 (0.8)	311 (1.0)	<0.01
Moderate	3665 (35.1)	1278 (37.8)		15,624 (13.5)	4,837 (14.8)
Major	4408 (42.2)	1424 (42.2)		64,258 (55.4)	18,008 (55.0)
Extreme	1811 (17.3)	508 (15.0)		35,259 (30.4)	9,573 (29.2)
Comorbidities,^b n (%)
Hypertension	4097 (39.2)	1276 (37.8)	0.14	100,320 (86.5)	28,436 (86.9)	0.05
Type 2 Diabetes Mellitus	1840 (17.6)	591 (17.5)	0.89	63,533 (54.8)	17,870 (54.6)	0.60
CVD including MI	1416 (13.5)	426 (12.6)	0.16	60,766 (52.4)	17,878 (54.6)	<0.01
Febrile Neutropenia	1205 (11.5)	360 (10.7)	0.17	471 (0.4)	135 (0.4)	0.87
Sepsis	819 (7.8)	233 (6.9)	0.07	11,504 (9.9)	2,875 (8.8)	<0.01
CHF	800 (7.7)	227 (6.7)	0.07	59,675 (51.4)	16,297 (49.8)	<0.01
HIV	192 (1.8)	63 (1.9)	0.91	979 (0.8)	266 (0.8)	0.59
Myelodysplastic Syndrome	142 (1.4)	56 (1.7)	0.20	2,808 (2.4)	715 (2.2)	0.01
Concomitant Iron Supplementation,^c n (%)
IV iron	398 (3.8)	75 (2.2)	<0.01	12,323 (10.6)	3,517 (10.7)	0.52
Oral iron	148 (1.4)	21 (0.6)	<0.01	7,377 (6.4)	1,868 (5.7)	<0.01

EPO, epoetin alfa; DARB, darbepoetin alfa; SD, standard deviation; CVD, cardiovascular diseases; MI, myocardial infarction; CHF, congestive heart failure; HIV, human immunodeficiency virus; IV, intravenous.

^aSeverity level for the admission diagnosis-related group as defined by 3M’s algorithm.

^bIdentified from primary or secondary admitting International Classification of Diseases, 9^th Revision, diagnoses.

^cIdentified from billing codes.

Table 2.  Utilization of EPO vs DARB for patients with cancer chemotherapy or pre-dialysis chronic kidney disease.

	Cancer chemotherapy		Pre-dialysis chronic kidney disease
	EPO	DARB	EPO	DARB
Inpatient settings	n = 10,454	n = 3378	n = 116,017	n = 32,729
Mean length of hospital stay, days ± SD	13.4 ± 14.2	12.6 ± 13.4	9.9 ± 9.6	9.7 ± 9.1
Mean cumulative dose, units or mcg ± SD	62,605 ± 58,489	272 ± 196	37,333 ± 37,218	149 ± 128
Dose ratio (Units of EPO: mcg of DARB)	230:1		251:1
WAC prices
Cumulative ESA cost, US$ ± SD	$948 ± $886	$1348 ± $971	$566 ± $564	$738 ± $637
Cost premium associated with DARB*	42%		30%
ASP + 6% prices
Cumulative ESA cost, US$ ± SD	$627 ± $585	$829 ± $597	$374 ± $373	$454 ± $391
Cost premium associated with DARB*	32%		21%
Outpatient settings	n = 2856	n = 2734	n = 6921	n = 4091
Mean treatment duration, months ± SD	2.6 ± 1.3	2.5 ± 1.2	3.6 ± 3.5	3.4 ± 2.7
Mean cumulative dose, units or mcg ± SD	221,652 ± 167,099	933 ± 535	137,101 ± 150,017	533 ± 483
Dose ratio (Units of EPO: mcg of DARB)	238:1		257:1
WAC prices
Cumulative ESA cost, US$ ± SD	$3358 ± $2532	$4627 ± $2655	$2077 ± $2273	$2642 ± $2395
Cost premium associated with DARB*	38%		27%
ASP + 6% prices
Cumulative ESA cost, US$ ± SD	$2219 ± $1673	$2845 ± $1632	$1372 ± $1502	$1625 ± $1473
Cost premium associated with DARB*	28%		18%

EPO, epoetin alfa; DARB, darbepoetin alfa; SD, standard deviation; mcg, micrograms; ESA, erythropoeisis-stimulating agent; WAC, wholesale acquisition costs; ASP, average selling price.

*Calculated as the following: (DARB cumulative cost – EPO cumulative cost)/EPO cumulative cost.

Figure 1.  Cumulative ESA cost for patients with cancer receiving chemotherapy based on WAC prices pre- and post-NCD (July 2007).

Figure 2.  Cumulative ESA cost for patients with pre-dialysis chronic kidney based on WAC prices pre- and post-guidelines modification (March 2007).