Patients on dialysis who receive erythropoiesis-stimulating agents (ESAs) for the treatment of anemia maintain a better health-related quality of life (HRQoL) and incur lower health-care costs than those not receiving ESAs, according to a new systematic review published in the Journal of Medical Economics.

Of 15 studies conducted mostly in North America and Europe, 2 randomized controlled trials reported that ESA treatment improved HRQoL in clinically meaningful ways compared with placebo, Bruce Spinowitz, MD, of New York-Presbyterian Queens, and colleagues reported. In 8 studies, aiming for higher hemoglobin (Hb) targets of around 12 g/dL with ESAs resulted in only modest improvement in HRQoL, typically with regard to energy and fatigue.

With respect to economic burden, treating patients with ESAs resulted in lower costs and health-care resource utilization (HRU) than prescribing no ESAs in 2 studies. Targeting higher Hb led to reduced HRU in 1 study and reduced cost-effectiveness in 2 more.

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“With respect to costs, studies showed that, in spite of the high acquisition cost of ESAs, non-treatment of CKD-related anemia entailed higher medical costs and HRU that outweighed ESA costs, highlighting the importance of treating this condition given its economic burden,” Dr Spinowitz and the team commented. “Aiming for Hb targets above 12 g/dL incurred higher HRU and costs, and translated into limited gains in QALY [quality-adjusted life years], and, thus, higher costs per QALY gained.”

Meta-analyses were not possible due to heterogeneity among studies, which limits interpretation of the data. In addition, no studies investigated red blood cell transfusions or iron supplementation separately from ESAs.

The review was funded by Akebia Therapeutics, Inc.

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Spinowitz B, Pecoits-Filho R, Winkelmayer WC, et al. Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review. J Med Econ. DOI:10.1080/13696998.2019.1588738