The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney DiseaseReportar como inadecuado




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Background

Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents ESAs for managing chronic anemia in persons with chronic kidney disease CKD, there are differences in the recommended hemoglobin Hb treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3–4.

Methods and Findings

The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3–4 i.e., not on dialysis and anemia created from the 1999–2010 National Health and Nutrition Examination Survey. Incremental cost-effectiveness ratios ICERs, computed as incremental cost divided by incremental quality adjusted life years QALYs, were assessed for Hb targets of 10 g-dl to 13 g-dl at 0.5 g-dl increments. Targeting a Hb of 10 g-dl resulted in an ICER of $32,111 compared with no treatment and targeting a Hb of 10.5 g-dl resulted in an ICER of $32,475 compared with a Hb target of 10 g-dl. QALYs increased to 4.63 for a Hb target of 10 g-dl and to 4.75 for a target of 10.5 g-dl or 11 g-dl. Any treatment target above 11 g-dl increased medical costs and decreased QALYs.

Conclusions

In persons over age 30 with CKD stages 3–4, anemia treatment is most cost-effective when targeting a Hb level of 10.5 g-dl. This study provides important information for framing guidelines related to treatment of anemia in persons with CKD.



Autor: Benjamin O. Yarnoff , Thomas J. Hoerger, Siobhan A. Simpson, Meda E. Pavkov, Nilka R. Burrows, Sundar S. Shrestha, Desmond E. Wil

Fuente: http://plos.srce.hr/



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