|
Press Release
Potential for Significant Cost Savings in Epoetin Administration to End-Stage Renal Disease Patients According to New Study
For Release on Thursday, February 28, 2002 at 5:00 AM, ET
End-stage renal disease patients routinely receive recombinant human erythropoietin (epoetin) as part of their treatment. Among its benefits are increased hematocrit levels and improved cardiovascular function and overall quality of life. However, epoetin treatment is costly. Medicare costs for treating end-stage renal disease patients with epoetin are estimated to have been more than $600 million in 1998. Logically, because of the significant expense, strategies to reduce the cost of epoetin administration are being actively explored. Researchers from the Department of Veterans Affairs Cooperative Studies Program and the Centers for Medicare & Medicaid Services End-Stage Renal Disease Work Group Collaborative Study found that using subcutaneous rather than intravenous administration enabled them to reduce the dosage while maintaining target hematocrit levels. The implications for reducing treatment costs are significant. The results of their study were published today in The American Journal of Medicine.
"This study is an excellent example of how clinical research can identify the most cost-efficient and optimal care for veterans and the public sector" said John R. Feussner, M.D., M.P.H., VA's Chief Research and Development Officer and co-author of the study. "Through the combined resources and efforts of this collaborative study, VA clinical research results have shown that cost effective measures and optimal patient care can be translated into health care policy."
Data for the study was gathered from three primary sources. In a Department of Veterans Affairs randomized controlled trial conducted in hemodialysis units at 24 Department of Veterans Affairs medical centers (208 patients), a one-third less dose of recombinant human epoetin was shown to attain recommended target hematocrit levels of 30% to 33% when administered subcutaneously compared with intravenously. The half-life of epoetin is prolonged with subcutaneous administration suggesting that lower doses could be used. (The National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines have since recommended a target hematocrit level of 33% to 36%.) Data were also gathered from the 1998 Centers for Medicare & Medicaid Services' End-Stage Renal Disease Core Indicators Project (5166 patients) and 1997-1998 Medicare claims files.
The researchers used an economic cost projection model to estimate potential savings to the Medicare End-Stage Renal Disease Program that could occur during a transition from intravenous to subcutaneous administration of epoetin among hemodialysis patients. To model the transition process, they estimated the Medicare savings that might occur if 25%, 50%, 75%, and 100% of patients who received intravenous epoetin switched to the subcutaneous route. Medicare cost savings were estimated at $47 to $142 million annually as 25% to 75% of hemodialysis patients who received epoetin intravenously switched to subcutaneous administration while reducing the dose by 32%. The authors project that a minimal reduction (10%) in epoetin dose would result in Medicare cost savings of an estimated $15 to $44 million annually. They also point out that for the transition to occur, consensus among stakeholders is needed, especially among patients whose treatment satisfaction and health-related quality of life would be most affected.
"We found that there is the potential for substantial Medicare cost savings if the epoetin route of administration is switched and the dose is reduced," said lead author Denise Hynes, Ph.D. "Patients, physicians, and dialysis facilities can affect whether the switching and dose reductions occur. Yet, because epoetin is a separately billable item not included in the Medicare composite rate facilities are paid per dialysis session, reducing the epoetin dose might also impact facility revenues. Any reconsideration of Medicare's reimbursement strategies for separately billable items such as epoetin cannot be undertaken in isolation without considering the entire dialysis payment structure."
Despite the National Kidney Foundation-Dialysis Outcome Quality Initiative that recommends the subcutaneous route, most patients undergoing hemodialysis still receive epoetin intravenously. However, approximately 70% of patients at Department of Veterans Affairs hemodialysis centers have been switched to subcutaneous administration.
The results of this study are reported in "Potential Cost Savings of Erythropoietin Administration in End-Stage-Renal Disease" by Denise M. Hynes et al., published in The American Journal of Medicine, February 28, 2002, Volume 112, Number 3, published by Elsevier Science. The full text of this article is available upon request.
For further information regarding this study, please contact Thomas Grego at the Hines VA Medical Center, (708) 202-2716.
###
|
