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NEPHROLOGY

Darbepoetin Alfa Therapeutic Interchange Protocol for Anemia in Dialysis

Associate Professor of Pharmacy and Medicine, School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia (VCU/MCV), Richmond, VA

Elizabeth BD Ripley, MD MSc

Associate Professor of Internal Medicine, Division of Nephrology, School of Medicine, VCU/MCV

Denise R Kockler, PharmD

Director of Drug Information, VCU Health System

Seina Lee

PharmD Student, School of Pharmacy, VCU/MCV

Lori A Proeschel, PharmD

At time of writing, Pharmacy Practice Resident, VCU Health System; now, Clinical Specialist, Sentara Health System, Norfolk, VA

Reprints: Dr. Brophy, VCU/MCV School of Pharmacy, PO Box 980533, Richmond, VA 23298-0533, fax 804/828-8359, Dbrophy{at}vcu.edu

BACKGROUND: Erythropoiesis-stimulating proteins, such as erythropoietin alfa and darbepoetin alfa, have positively impacted anemia management. These medications improve patient outcomes and quality of life. Their costs, however, remain a major barrier for health systems.

OBJECTIVE: To evaluate the development, implementation, and cost-effectiveness of an inpatient therapeutic interchange protocol for erythropoiesis-stimulating proteins at a large, tertiary care, university-affiliated health system.

METHODS: Virginia Commonwealth University Health System (VCUHS) developed and implemented a therapeutic interchange program to convert therapy for all inpatients undergoing dialysis from erythropoietin alfa to darbepoetin alfa for treatment of chronic kidney disease-related anemia. An evaluation of the economic impact of this program on drug expenditures over a fiscal quarter (2003) was conducted using historical comparator data (2002).

RESULTS: Preliminary evaluation of the program demonstrated cost-savings and reduced drug utilization of erythropoiesis-stimulating proteins in hospitalized dialysis patients. For the first quarter of 2003 compared with the first quarter of 2002, VCUHS realized a cost-savings of nearly $10 000, which was related to the program's aggressive screening procedure. When these data were normalized for equal numbers of patients in each group receiving one of the drugs, the actual cost-savings was over $2000. These cost-savings are largely due to reduced utilization of these expensive biotechnology products with implementation of a dosing protocol.

CONCLUSIONS: VCUHS has successfully developed and implemented a darbepoetin alfa therapeutic interchange protocol for hospitalized dialysis patients. This has translated into reduced use of erythropoiesis-stimulating proteins, resulting in cost-savings for the health system.

Key Words: darbepoetin alfa, erythropoietin alfa; anemia, dialysis

Published Online, September 27, 2005. www.theannals.com, DOI 10.1345/aph.1G329