Factors influencing route of administration for epoetin treatment among hemodialysis patients in the United States.
Factors influencing route of administration for epoetin treatment among hemodialysis patients in the United States.
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影响美国血液透析患者促红细胞生成素治疗给药途径的因素。
DOI：
10.1053/j.ajkd.2006.03.040
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Cotter,DennisJ
中科院分区：
文献类型：
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作者：
Thamer,Mae;Zhang,Yi;Kaufman,James;Stefanik,Kevin;Cotter,DennisJ
已发表的临床指南提倡皮下（SC）给药促生成素治疗，尽管只有7%的血液透析患者采用皮下给药。尽管存在这种差异，但很少有研究检查与血液透析患者给药途径相关的因素。方法采用美国医疗保险和医疗补助服务中心终末期肾病临床表现测量项目的数据，对1999年10月至2000年12月在3069家透析机构接受血液透析的13854例患者进行分析。采用t检验和卡方检验检验未调整相关性。通过使用广义估计方程来估计调整后的相关性，以控制同一透析设施内患者的聚类。结果在美国，各地使用促生成素给药的SC途径差异很大。在对患者的社会人口统计和合并症进行调整后，最高的SC治疗率出现在中西部和西部，在不隶属于连锁机构的提供者中，在以医院为基础的和不以营利为目的的独立单位中。先前暴露于SC管理（作为透析前或腹膜透析患者）预测随后的SC使用，营利性和大型连锁店使用SC管理的可能性显着降低，总体注射药物使用的增加（以最大化收入）与SC使用的减少相关。结论除了SC使用的地区差异外，研究结果表明，医生对epoetin给药途径的决策主要受所有权类型和财务激励的影响。遵守已发表的临床指南并不是使用SC的一致预测因素。考虑到SC促生成素具有相似的疗效，但显著降低了剂量，这些发现表明，医疗保险计划有巨大的机会节省成本。
BackgroundPublished clinical guidelines advocate subcutaneous (SC) administration for epoetin therapy, although this is practiced among only 7% of all hemodialysis patients. Despite this disparity, few studies have examined factors associated with route of epoetin administration in hemodialysis patients.MethodsData from the Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project were used to identify 13,854 patients receiving hemodialysis in 3,069 dialysis facilities from October to December in 1999 and 2000. Unadjusted associations were examined by using t-test and chi-square test. Adjusted associations were estimated by using generalized estimating equations to control for clustering of patients within the same dialysis facility.ResultsIn the United States, use of the SC route of epoetin administration varies widely across the country. After adjusting for patient sociodemographics and comorbidities, the greatest rates of SC therapy are found in the Midwest and West, in providers not affiliated with chains, and in hospital-based and not-for-profit freestanding units. Previous exposure to SC administration (as a predialysis or peritoneal dialysis patient) predicted subsequent SC use, for-profit and large chains were significantly less likely to use SC administration, and increased use of injectable drugs overall (to maximize income) was associated with less SC use.ConclusionIn addition to regional variation in SC use, study findings indicate that physician decision making for epoetin administration route is influenced primarily by type of ownership and financial incentives. Adherence to published clinical guidelines was not a consistent predictor of SC use. Given the similar effectiveness, but significantly decreased dose associated with SC epoetin, these findings suggest an enormous opportunity for cost savings for the Medicare program.