Original Research
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction:
Anemia is one of the most prominent complications in patients with end-stage renal disease (ESRD). There is a constant need to use higher doses of recombinant human erythropoietin (EPO) in order to manage anemia and maintain target hemoglobin (Hgb) levels, especially in patients with EPO hyporesponsiveness. Vitamin D deficiency appears to play a role in overcoming this hyporesponsiveness to EPO.
Research Question or Hypothesis:
A cost effectiveness analysis was conducted to compare the cost and the clinical outcomes of adding oral weekly 50.000 IU vs. oral monthly 200.000 IU of cholecalciferol (native form of Vitamin D3) to the standard care therapy in hemodialysis (HD) outpatients.
Study Design:
A decision analysis model from a payer’s perspective was applied. Primary data of a single-blind randomized clinical trial conducted in Ain Shams University hospital (Tertiary setting) in Egypt was used.
Methods:The impact of both regimens on the cumulative dose of EPO and anemia measurements improvement was assessed. Drug costs were based on the wholesaler purchasing database used by Ain Shams University Hospital Pharmacy, Cairo, Egypt. One-way sensitivity analyses were performed to assess the robustness of the model.
Results:
The cost effectiveness ratio (cost per patient achieving the goal of 25% EPO dose reduction, with or without anemia improvement) markedly favors the weekly regimen (USD 540) and dominates the monthly regimen (USD 2,267). One-way sensitivity analyses showed these findings to be robust to changes in cholecalciferol costs and probabilities of cholecalciferol effectiveness in improving anemia.
Conclusion:
The model suggests that oral weekly 50.000IU of cholecalciferol is substantially more cost effective than monthly oral 200.000IU cholecalciferol, in terms of anemia improvement and of cumulative dose reduction of EPO by 25%.
Presenting Author
Mona Alshahawey M.Sc, PhD Clinical PharmacyAin Shams University - School of Pharmacy
Authors
David Holdford PhD
Virginia Commonwealth University, Virginia, United States
Tamer Elsaid MD Nephrology
Ain Shams Univeristy - School of Medicine
Teresa M. Salgado MPharm, PhD
Virginia Commonwealth University School of Pharmacy