OBJECTIVES: To quantify and compare staff time related to anaemia management with currently available ESA drugs in haemodialysis centres and to model the potential efficiency gains with adoption of once-monthly C.E.R.A. (continuous erythropoietin receptor activator) injections. METHODS: A multicentre, prospective, activity-based costing study was undertaken in 17 dialysis centres across 3 countries. Tasks were grouped into observable tasks (ESA preparation and administration) and quantified through time and motion observations. Time for non-observable tasks (e.g. ESA inventory/ordering, blood sampling, physician review) was estimated through staff interviews. Time was translated into cost using estimates of national wages for personnel. ESA acquisition costs were excluded. RESULTS: Average observed time and cost per ESA administration was 1.67 minutes (€0.53) in Germany, 2.67 minutes (€1.55) in the UK and 2.35 minutes (€1.92) in the US. Time per patient per year varies primarily due to the different mix of products and their frequency of administrations. The weighted average number of ESA injections per patient per week (year) was 1.8 (94) across the German centres, 1.6 (83) in the UK and 3 (155) in the US centres. Time for non observable tasks account for 40 to 60% of the total time related to anaemia activities. Modelling estimated that with once-monthly C.E.R.A time for the observed activities would be 28 to 32 minutes per patient per year (>80% reduction). Additional savings could be generated related to non-observable tasks. The order of magnitude of these savings may vary according to the organization of the centres. CONCLUSION: Anaemia management with ESAs appears fairly standardized across dialysis centres and countries and accounts for a significant amount of staff time. With 12 injections of C.E.R.A. per patient per year, substantial time savings could be achieved enabling centres to focus on other aspects of patient care.