WITHDRAWN Can the Choice of Erythropoietin Impact the Treatment Cost in Chronic Kidney Disease?

OBJECTIVES:

To analyse how erythropoietin (EPO) use affect total cost of treatment in end-stage renal disease (ESRD) patients undergoing hemodialysis

METHODS:

Study site:

A tertiary care hospital in South India

Study duration:

January - December 2020

Study type:

Cross-sectional

Subjects:

All ESRD patients who underwent hemodialysis during study period meeting inclusion criteria (120 patients)

RESULTS:

Seven different brands of erythropoietin alfa were used in hospital. Brand (I) was used in 43 (40%), brand (II) in 31 (29%), brand (III) in 21 (20%) and brand (IV) in 12(11%) patients either as 4000 IU or 10000 IU. These were sold at Maximum Retail Price (MRP) to the patients and MRP per vial for 4000 IU EPO alpha were 1480 ($18.74), 1283 ($16.25), 1480 ($18.74) and 1111($14.07) rupees whereas, 10000 IU was sold at 2905 ($36.79), 3620 ($45.84), 2905 ($36.79) and 3047 ($38.59) rupees for brands I,II, III and IV respectively. For patients who follow once-weekly and twice-weekly regimens, the difference in the unit cost of the least expensive and most expensive brands of 4000 IU EPO was ₹369 and ₹738 and for 10000 IU, it was ₹715 and ₹1430 respectively.

Erythropoietin resistance index (ERI) was obtained by weekly weight adjusted erythropoietin dose (U/kg/week) divided by haemoglobin concentration (g/dl). This is an indicator of how well patient responds to therapy. Four brands studied had comparable ERI and so choosing least expensive brand may not affect increase in haemoglobin in ESRD patients with anaemia.

CONCLUSIONS:

Average daily income of a lowest paid Indian worker is ₹382 ($4.83) and ESRD patients may not be engaged in any work. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. So, choosing an economical and efficacious brand is crucial.