Objective

Erythropoiesis-stimulating agent (ESA) is effective in treating renal anemia but at the expense of increased risks for adverse events (AEs) which incur a substantial economic burden. However, this issue is yet well researched. This study aims to estimate the economic burden of AEs associated with ESA therapy among chronic kidney disease (CKD) patients from Taiwan’s healthcare perspective.

Method

Using Taiwan’s National Health Insurance Research Database, we identified incident CKD patients who used ESA between 2009 and 2017 as our study subjects. We further categorized them into non-dialysis (NDD), dialysis dependent (DD), and incident dialysis (ID) groups based on their dialysis status. All eligible study subjects needed to have at least one year of follow-up. Crude incidences of admissions for AEs (including deep vein thrombosis, hypertensive emergency, vascular access thrombosis) and associated costs (U.S. dollars) were examined.

Result

A total of 942,723 incident CKD patients were identified, of which 94.28% were in the NDD group (n=888,785; mean age 64.8 ± 16.3 years), 2.54% in the DD group (n=23,959; mean age 64.8 ± 16.3 years), and 3.18% in the ID group (n=29,979; mean age 62.5 ± 12.5 years).

Hypertensive emergency was the most frequently identified AE across all three groups although the incidences varied in different groups (21.83%, 5.81%, 8.46% in the NDD, DD, ID groups, respectively).

Nevertheless, deep vein thrombosis ($10628.31) incurred the largest costs in the DD group, and vascular access thrombosis incurred the largest costs in the NDD ($7936.49) and the ID ($8509.46) group.

Conclusion

Hypertensive emergency was the most frequently identified AE across all three groups although the incidences varied in different groups. However, deep vein thrombosis incurred the largest costs in the DD group, and vascular access thrombosis incurred the largest costs in both the NDD and the ID group.