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PHARMACOECONOMICS

Cost Analytic Model to Determine the Least Costly Inpatient Erythropoiesis Stimulating Therapy Regimen

Clinical Director/Residency Director, Scripps Mercy Hospital; Cardinal Health, San Diego, CA

Adam Decter, MBA MA

Vice President, Analysis Group, Inc., Boston, MA

Tina Greco, PharmD

Clinical Pharmacist, Scripps Mercy Hospital

Sue H Watson, PharmD

Field Director, Outcomes Group, Ortho Biotech Clinical Affairs, LLC., Bridgewater, NJ

Yoon Jun Kang, BA

Senior Analyst, Analysis Group, Inc.

Samir H Mody, PharmD MBA

Assistant Director, Outcomes Research, Clinical Affairs, Ortho Biotech Clinical Affairs, LLC.

Catherine Tak Piech, MBA

Vice President, Outcomes and Biometrics, Ortho Biotech Clinical Affairs, LLC.

Mei Sheng Duh, MPH ScD

Vice President, Analysis Group, Inc.

Ayesha Naeem, BA

Senior Analyst, Analysis Group, Inc.

Reprints: Mr. Decter, Analysis Group, Inc., 111 Huntington Ave., 10th Floor, Boston, MA 02199, fax 617/425-8001, adecter{at}analysisgroup.com

BACKGROUND: Unlike in outpatient settings, the comparative costs of epoetin alfa (EPO) and darbepoetin alfa (DARB) have not been evaluated broadly from the inpatient hospital perspective.

OBJECTIVE: To develop a cost analytic model comparing hospital inpatient costs for erythropoiesis stimulating therapies within the nephrology and oncology settings.

METHODS: A cost analytic model incorporating erythropoietic drug, pharmacy, and nursing costs was developed from the inpatient hospital perspective to evaluate comparative costs of EPO and DARB. Erythropoietic drug costs were calculated using unit wholesale acquisition cost multiplied by the number of units or micrograms while comparing the following dosing regimens: EPO 3 times weekly, EPO once weekly, and DARB once weekly. Pharmacy costs included dispensing and delivery costs, while nursing costs incorporated administration time costs; all were calculated by estimated fractional hours per activity multiplied by hourly wages. The total frequency of erythropoiesis stimulating therapy administrations was determined based on the average hospital length of stay. The first erythropoiesis stimulating therapy dose was assumed to occur on day 3 of hospitalization. For total inpatient costs, a weighted average was calculated across disease states. One-way sensitivity analyses were conducted by varying length of stay, day of initial erythropoiesis stimulating therapy dose, pharmacy and nursing costs, and once-weekly DARB dose.

RESULTS: EPO 3 times weekly was the least costly regimen across all disease states evaluated. Threshold analysis indicated that the cost of once-weekly DARB regimens would have to be reduced by 37% to equal the cost of EPO 3 times weekly for an average length of stay. Sensitivity analyses did not considerably affect the results.

CONCLUSIONS: EPO 3 times weekly was found to be the least costly erythropoiesis stimulating therapy regimen for nephrology and oncology inpatients for the average length of stay as well as most other lengths of stay considered. Once-weekly EPO was the least costly erythropoiesis stimulating therapy regimen for several other lengths of stay, while once-weekly DARB was never found to be the least costly regimen.

Key Words: anemia, cost, darbepoetin alfa, epoetin alfa

Published Online, November 20, 2007. www.theannals.com, DOI 10.1345/aph.1K061