In the olden days of dialysis—before epoetin was introduced in 1989—roughly 10% of end-stage renal disease (ESRD) patients frequently received infusions of blood units to treat anemia. And another 20% of dialysis patients received the occasional blood unit infusion for mild anemia. “By 2005, however, 99% of in-center hemodialysis patients received epoetin treatment” for anemia. “How did this therapy diffuse to near universal use among the dialysis population? Was this diffusion backed up by solid scientific evidence? How can it be that a comprehensive technology assessment has not been conducted more than two decades after epoetin has been on the market?”
These are questions posed by Dennis Cotter in “The National Center for Health Care Technology: Lessons Learned,” published in the Health Affairs weblog.
Cotter notes that the mean dose of epoetin has increased by a factor of four in dialysis patients and “Medicare expenditures for epoetin rose to ~US$2 billion in 2004, comprising 11% of all Medicare ESRD costs.” The two existing clinical trials investigating eopetin had to be terminated, Cotter reports, “due to higher mortality rates in the higher target hematocrit treatment arms.”
As a dialysis patient, I can tell when my anemia worsens—I feel much worse than usual (which is almost always pretty bad)—and I’m thankful for access to epoetin. I wouldn’t be able to work full time, for example, without it and my quality of life would be even lower than it is already. That said, I find it extremely disturbing that a comprehensive technology assessment has yet to be conducted on the drug. And I find the dosage increase alarming. Are kidney failure patients really getting that much more anemic, or is something else going on?
Cotter offers his case-study to the proposed Federal Health Board. It’s an important and worthwhile step.
Image credit: Amgen, Inc.
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