Outcomes/Effectiveness Research

Use of subcutaneous instead of IV erythropoietin for end-stage renal disease patients could reduce Medicare costs

Recombinant human erythropoietin (epoetin) stimulates production of red blood cells and improves cardiovascular function and overall quality of life in patients with end-stage renal disease (ESRD), who have lost most kidney functioning.

Most ESRD patients undergoing hemodialysis receive epoetin intravenously, including 90 percent of those in the Medicare End-Stage Renal Disease Program, despite recommendations by the National Kidney Foundation for the subcutaneous route. Treating ESRD patients with subcutaneous epoetin would maintain the target hematocrit level at far less cost than the IV epoetin currently being used, concludes a study supported in part through an interagency agreement between the Agency for Healthcare Research and Quality and the Department of Veterans Affairs.

Denise M. Hynes, Ph.D., of Loyola University, and her colleagues used an economic cost projection model to estimate potential savings to the Medicare ESRD Program that could occur during a transition from IV to subcutaneous administration of epoetin among hemodialysis patients. They developed the model using data from a Department of Veterans Affairs clinical trial, a 1998 ESRD core indicators survey, and 1997-1998 Medicare claims files. The model estimated Medicare cost savings at $47 million to $142 million annually as 25 percent to 75 percent of hemodialysis patients who received IV epoetin switched to subcutaneous epoetin, while reducing the dose by 32 percent.

A minimal dose reduction (10 percent) would result in Medicare cost savings of $15 million to $44 million annually. Based on the model, use of subcutaneous epoetin reduced the dose per month by 10 percent, lowered the number of administrations per month, and reduced the costs compared with use of IV epoetin. Since the half-life of epoetin is prolonged with subcutaneous administration, lower doses can be used to maintain a target hematocrit level via this route.

See "Potential cost savings of erythropoietin administration in end-stage renal disease," by Dr. Hynes, Kevin T. Stroupe, Ph.D., Joel W. Greer, Ph.D., and others, in the February 15, 2002 American Journal of Medicine 112, pp. 169-175.

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