An Economic Evaluation of Erythropoiesis-Stimulating Agents in CKD
An Economic Evaluation of Erythropoiesis-Stimulating Agents in CKD
复制标题
DOI：
10.1053/j.ajkd.2010.07.015
复制
发表时间：
2010-12-01
影响因子：
13.2
通讯作者：
Manns, Braden J.
中科院分区：
文献类型：
--
作者：
Clement, Fiona M.;Klarenbach, Scott;Manns, Braden J.
工作背景：本研究的目的是确定使用红细胞生成刺激剂（ESA）治疗慢性肾脏病（CKD）贫血患者的成本效益，（9-10.9 g/dL），中间（11-12 g/dL）或高（> 12 g/dL）血红蛋白水平目标与不使用ESA的贫血管理策略进行比较。研究设计：成本效用分析。公共资助的医疗保健系统。CKD贫血患者，总体和分层为透析/非透析依赖亚组。模型、视角和时间范围：决策分析、医疗保健支付者、患者寿命。主要结果：获得的每质量调整生命年（QALY）成本。结果：对于透析患者，与不使用ESA的贫血管理相比，使用ESA以低血红蛋白水平为目标的每QALY成本为96，270美元。由于缺乏比较低和中等目标的直接试验，这些战略之间存在很大的不确定性。与低血红蛋白目标相比，高血红蛋白目标的治疗总是与更差的临床结局和更高的成本相关。结果在非透析依赖型CKD患者中相似，低目标与无ESA的每QALY成本为147，980美元。局限性：鉴于现有随机对照试验的局限性，我们只能模拟4种治疗策略，在考虑相关目标的需要与准确估计临床效果的要求之间进行平衡。我们假设不同策略的疗效将持续患者的lifesty.Conclusions：与使用ESA靶向较低的血红蛋白水平（9-12 g/dL）相比，使用ESA靶向血红蛋白水平> 12 g/dL与更差的临床结果和显著的额外成本相关。由于缺乏比较低（9-10.9 g/dL）和中等（11-12 g/dL）血红蛋白目标的临床结局（包括生活质量）的研究，因此9-12 g/dL范围内最具成本效益的血红蛋白水平目标尚不确定，尽管在此范围内瞄准更高的目标将导致更高的成本。美国肾脏病杂志56：1050-1061。(C)2010年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: The objective was to determine the cost-effectiveness of treating anemic patients with chronic kidney disease (CKD) with erythropoiesis-stimulating agents (ESAs) to a low (9-10.9 g/dL), intermediate (11-12 g/dL), or high (> 12 g/dL) hemoglobin level target compared with a strategy of managing anemia without ESAs.Study Design: Cost-utility analysis.Setting & Participants: Publicly funded health care system. Anemic patients with CKD, overall and stratified into dialysis-/non-dialysis-dependent subgroups.Model, Perspective, & Timeframe: Decision analysis, health care payer, patient's lifetime.Main Outcome: Cost per quality-adjusted life-year (QALY) gained.Results: For dialysis patients, compared with anemia management without ESAs, using ESAs to target a low hemoglobin level is associated with a cost per QALY of $ 96,270. Given a lack of direct trials comparing low and intermediate targets, significant uncertainty exists between these strategies. Treatment to a high hemoglobin target was always associated with worse clinical outcomes and higher costs compared with a low hemoglobin target. Results were similar in non-dialysis-dependent patients with CKD, with a cost per QALY for a low target compared with no ESA of $ 147,980.Limitations: Given limitations in the available randomized controlled trials, we were able to model only 4 treatment strategies, balancing the need to consider relevant targets with the requirement for accurate estimates of clinical effect. We assumed that the efficacy of the different strategies would continue over a patient's lifetime.Conclusions: Using ESAs to target a hemoglobin level > 12 g/dL is associated with worse clinical outcomes and significant additional cost compared with using ESAs to target lower hemoglobin levels (9-12 g/dL). Given a lack of studies comparing low (9-10.9 g/dL) and intermediate (11-12 g/dL) hemoglobin targets for clinical outcomes, including quality of life, the most cost-effective hemoglobin level target within the range of 9-12 g/dL is uncertain, although aiming for higher targets within this range will lead to higher costs. Am J Kidney Dis 56: 1050-1061. (C) 2010 by the National Kidney Foundation, Inc.