Economic Burden and Health-Related Quality of Life Associated with Current Treatments for Anaemia in Patients with CKD not on Dialysis: A Systematic Review

Pablo E. Pergola, Roberto Pecoits-Filho, Wolfgang C. Winkelmayer, Bruce Spinowitz, Samuel Rochette, Philippe Thompson-Leduc (), Patrick Lefebvre, Gigi Shafai, Ana Bozas, Myrlene Sanon and Holly B. Krasa
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Pablo E. Pergola: Renal Associates PA
Roberto Pecoits-Filho: George Institute for Global Health
Wolfgang C. Winkelmayer: Baylor College of Medicine
Bruce Spinowitz: NewYork-Presbyterian Queens
Samuel Rochette: Analysis Group, Inc.
Philippe Thompson-Leduc: Analysis Group, Inc.
Patrick Lefebvre: Analysis Group, Inc.
Gigi Shafai: Akebia Therapeutics
Ana Bozas: Akebia Therapeutics
Myrlene Sanon: Otsuka Pharmaceutical Development and Commercialization
Holly B. Krasa: Otsuka Pharmaceutical Development and Commercialization

PharmacoEconomics - Open, 2019, vol. 3, issue 4, No 5, 463-478

Abstract: Abstract Background The cost and health-related quality of life (HRQoL) burden associated with treatments for anaemia of chronic kidney disease (CKD) is not well characterized among non-dialysis-dependent (NDD) patients. Objective Our objective was to review the literature on costs and HRQoL associated with current treatments for anaemia of CKD among NDD patients. Methods The Cochrane Library, MEDLINE, Embase, NHS EED, and NHS HTA databases were searched for original studies published in English between 1 January 2000 and 17 March 2017. The following inclusion criteria were applied: adult population; primary focus was anaemia of CKD; patients received iron supplementation, red blood cell transfusion, or erythropoiesis-stimulating agents (ESAs); and reported results on HRQoL and/or costs. Studies that included NDD patients, did not compare different treatments, and had relevant designs were retained. HRQoL and cost outcomes were summarized in a narrative synthesis. Results In total, 16 studies met the inclusion criteria: six randomized controlled trials, four prospective single-arm trials, three retrospective studies, one prospective observational study, one simulation study, and one cross-sectional survey. All included ESAs. Treatment of anaemia (compared with no treatment) was associated with HRQoL improvements in five of six studies and lower costs in four of four studies. Treatment aiming for higher haemoglobin targets (compared with lower targets) resulted in modest HRQoL improvements, higher healthcare resource utilization (HRU), and higher costs. Conclusions In NDD patients, untreated anaemia of CKD leads to higher costs, higher HRU, and lower HRQoL compared with initiating anaemia treatment. Relative to aiming for lower haemoglobin targets with ESAs, higher targets conferred modest HRQoL improvements and were associated with higher HRU.

Date: 2019
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DOI: 10.1007/s41669-019-0132-5

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