Probabilistic cost-minimisation analysis of darbepoetin alpha versus epoetin alpha in treating anaemia secondary to chronic renal failure. Assessment in Spanish clinical practice

Introduction

The direct transfer of the results of pharmaco-economic studies between countries may not be suitable if the proper adaptations are not made to take into account differences in treatment patterns, resource use, and costs from country to country.

Objective

To estimate the cost in Spain of treating anaemia secondary to chronic renal failure with darbepoetin alpha or epoetin alpha from a review and analysis of available current information. In addition, the role of the route of administration as a main driver of the cost will be analysed.

Method

Population: patients with chronic renal failure induced anaemia. Data: Medline and Embase search of studies directly comparing erythropoiesis stimulating agents. Analysis: Cost minimization analysis from the perspective of a hospital pharmacy department. The main outcome chosen was the difference between the average cost per patient undergoing a 30-day treatment with epoetin alpha versus darbepoetin alpha.

Results

a) Haemodialysis: changing from epoetin alpha to darbepoetin alpha is associated with a cost reduction of 8.67%; 95% CI, −1.34 to 17.92 (€uro17.48; 95% CI, −2.70 to 36.13); probabilistic analysis showed that the use of darbepoetin alpha could be associated with a costsaving probability of 94.9%. The IV administration yielded a decrease in costs of about 16.00%; 95% CI, −2.38 to 36.77 (€uro41.78, 95% CI: −6.21 to 96.04); b) Pre-dialysis: darbepoetin alpha is associated with a cost reduction of about 11%–32%.

Conclusions

The use of darbepoetin alpha for the treatment of chronic renal failure induced anaemia (haemodialysis and pre-dialysis) shows higher cost efficiency than epoetin alpha in Spain; these differences increase with IV administration.