Cost-effectiveness of Treating Chronic Anemia with Epoetin Alfa among Hemodialysis Patients in the United States

Objectives

The objectives of this analysis were to assess health and economic consequences of targeting hemoglobin (Hb) levels around 10-11 g/dL relative to 9-10 g/dL using an economic model and to explore the impact of different assumptions on cost-effectiveness.

Study Design

Clinical and economic impact of treating anemia in the US hemodialysis population to target Hb levels of 10-11 g/dL and 9-10 g/dL was assessed using a Markov model. A sensitivity analysis assessed the effects of varying assumptions on the model.

Results

Our cost-effectiveness analysis suggests that maintaining Hb 10-11 g/dL would result in average reductions of 0.51 hospitalizations and increases of 0.09 quality-adjusted life years per patient, with hospitalization cost offsets of $15,340 over 5 years when compared with Hb of 9-10 g/dL. Over the lifetime of the patient, cost-effectiveness improved with hospitalization cost offsets of $21,450 and increases of 0.12 quality-adjusted life years. Sensitivity analysis of individual parameters showed that mortality, hospitalization, health preference, and time horizon of the model had the most influence on cost-effectiveness.

Conclusions

Our analysis suggests that epoetin alfa use targeting Hb levels of 10-11 g/dL relative to 9-10 g/dL may result in better patient outcomes and lower costs. The sensitivity analysis highlighted how assumptions affected cost-effectiveness conclusions; the appropriateness of these assumptions will remain uncertain until new research in today’s dialysis population examining the effects of targeting to lower Hb levels is conducted.