Cost Effectiveness Analysis (CEA) Strategi Terapi Anemia pada Pasien Penyakit Ginjal Kronis

https://doi.org/10.22146/jmpf.72614

Nurfina Dian Kartikawati(1*), Tri Murti Andayani(2), Dwi Endarti(3)

(1) Gadjah Mada University
(2) Gadjah Mada University
(3) Gadjah Mada University
(*) Corresponding Author

Abstract


Chronic kidney disease (CKD) is a condition in which the kidneys are unable to maintain a fluid balance of metabolic waste that is progressive, irreversible, and takes place slowly. Anemia is a complication of CKD that contributes to morbidity, mortality, and quality of life of patients, as well as greater costs of care. This study aims to evaluate the differences in the effectiveness and cost of anemia therapy with epoetin in patients with chronic kidney disease. The study was conducted in an analytical-observational manner with a retrospective cohort design from the provider's perspective. The sample used was CKD patients with anemia who met the inclusion criteria for the period January - December 2020, data were taken from medical records and patient financial recapitulation. Statistical analysis was carried out on the effectiveness of anemia therapy with epoetin based on the achievement of clinical outcomes of increasing Hb values within 3 months and financing calculated based on direct medical costs. A total of 113 patients met the inclusion criteria, consisting of 96 patients in the epoetin alpha group and 17 patients in the epoetin beta group. The percentage of achieving therapeutic targets in the epoetin beta group was higher (11.76%) than in the epoetin alfa group (10.42%). The average increase in Hb in the EPO beta group was higher than in the EPO alpha group. The cost of epoetin for anemia treatment in the beta epoetin group (Rp 1,005,365) was lower than the epoetin alfa group (Rp 1,017,188). The ICER value obtained was IDR -125,966, indicating a cost savings of IDR 125,966 to increase 1% of the achievement of therapeutic targets for Hb values >10 g/dl. The cost of therapy with EPO beta is lower than EPO alpha and the achievement of Hb therapy targets is better in EPO beta than EPO alpha.


Keywords


anemia; chronic kidney disease; cost-effectiveness analysis (CEA)

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References

  1. Marriott J, Cockwell P, Stringe S. Chronic Kidney Disease and End-Stage Renal Disease. In: Whittlesea C, Hodson K, eds. Clinical Pharmacy and Therapeutics. Sixth edition. Elsevier; 2019:294-316.
  2. Sowinski KM, Churchwell MD, Decker BS. Chronic Kidney Disease. In: DiPiro JT, ed. The 11th Edition of Pharmacotherapy: A Pathophysiologic Approach. Eleventh edition. McGraw Hill Medical; 2020:1904-1991.
  3. Vondracek SF, Teitelbaum I, Kiser TH. Principles of Kidney Pharmacotherapy for the Nephrologist: Core Curriculum 2021. American Journal of Kidney Diseases. 2021;78(3):442-458. doi:10.1053/j.ajkd.2021.02.342
  4. KEMENKES RI. Profil Kesehatan Indonesia 2013. Published 2013. Accessed March 24, 2021. https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/profil-kesehatan-indonesia-2013.pdf
  5. Babitt JL, Lin HY. Mechanisms of Anemia in CKD. JASN. 2012;23(10):1631-1634. doi:10.1681/ASN.2011111078
  6. Stauffer ME. Prevalence of Anemia in Chronic Kidney Disease in the United States. Published online 2014.
  7. Cheung AK, Chang TI, Cushman WC, et al. KDIGO 2012 Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Published online 2012:64. doi:10.1038/kisup.2012.37
  8. Cases A, Egocheaga MI, Tranche S, et al. Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology. Nefrología (English Edition). 2018;38(1):8-12. doi:10.1016/j.nefroe.2018.01.007
  9. PERNEFRI. Konsensus Manajemen Anemia Pada Penyakit Ginjal Kronik. Published online 2011.
  10. Somvanshi S, Khan NZ, Ahmad M. Anemia in chronic kidney disease patients. Clinical Queries: Nephrology. 2012;1(3):198-204. doi:10.1016/j.cqn.2012.06.003
  11. Trisna Y. Aplikasi Farmakoekonomi. Published 2016. Accessed March 16, 2021. http://iai.id/news/artikel/aplikasi-farmakoekonomi
  12. Widianti C, Anggriani Y, Kusumaeni T, Meila O. Analisis Efektivitas Biaya Penggunaan Eritropoetin (HEMAPO® , EPOTREX®, RECORMON®) Pada Pasien Hemodialisis Di RSUP Persahabatan. Published online 2018:5.
  13. Insani N, Manggau MA, Kasim H. Analisis Efektivitas Terapi Pada Pasien Anemia Gagal Ginjal Hemodialisis Di Rsup Dr. Wahidin Sudirohusodo Makassar. MFF. 2018;22(1):13-15. doi:10.20956/mff.v22i1.5690
  14. Omrani HR, Golmohhamadi S, Hashemian AH, Vaysmoradi AZ, Safari-Faramani R. Therapeutic efficacy of erythropoietin alfa and erythropoietin beta in hemodialysis; a randomized controlled trial. J Renal Inj Prev. 2018;8(1):44-49. doi:10.15171/jrip.2019.09
  15. Azmandian J, Abbasi MR, Pourfarziani V, et al. Comparing Therapeutic Efficacy and Safety of Epoetin Beta and Epoetin Alfa in the Treatment of Anemia in End-Stage Renal Disease Hemodialysis Patients. Am J Nephrol. 2018;48(4):251-259. doi:10.1159/000493097
  16. Lemeshow S, Hosmer Jr DW, Klar J, Lwanga SK, eds. Adequacy of Sample Size in Health Studies. Published on behalf of the World Health Organization by Wiley ; Distributed in the U.S.A., Canada, and Japan by Liss; 1990.
  17. Arikunto S. Pengembangan Instrumen Penelitian Dan Penilaian Program. Pustaka Pelajar; 2017.
  18. Murtisiwi L. Perbandingan Kualitas Hidup Pasien yang Menjalani Hemodialisis dengan Terapi Epoetin Alfa dan Epoetin Beta di RS PKU Muhammadiyah Yogyakarta. jf. 2019;4(1):25. doi:10.37013/jf.v4i1.29
  19. Sihombing JP. Cost Effectiveness Analysis Eritropoetin α Ddibandingkan dengan Eritropoetin β Pada Pengobatan Anemia Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisa Rutin. Universitas Gadjah Mada. Published online 2019:202.
  20. Brown LJ, Clark PC, Armstrong KA, Liping Z, Dunbar SB. Identification of Modifiable Chronic Kidney Disease Risk Factors by Gender In an African-American Metabolic Syndrome Cohort. Nephrol Nurs J. 2010;37(2):133-142.
  21. Carrero JJ. Gender Differences in Chronic Kidney Disease: Underpinnings and Therapeutic Implications. Kidney Blood Press Res. 2010;33(5):383-392. doi:10.1159/000320389
  22. International Society of Nephrology. Definition and classification of CKD. Kidney Int Suppl (2011). 2013;3(1):19-62. doi:10.1038/kisup.2012.64
  23. CDC. Chronic Kidney Disease in the United States 2021. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. Published online 2021:4.
  24. USRDS. Unites States Renal Data System Annual Data Report 2020. USRDS. Published 2020. Accessed December 6, 2021. https://adr.usrds.org/
  25. Chae JW, Song CS, Kim H, Lee KB, Seo BS, Kim DI. Prediction of Mortality in Patients Undergoing Maintenance Hemodialysis by Charlson Comorbidity Index Using ICD-10 Database. Nephron Clin Pract. 2010;117(4):379-384. doi:10.1159/000321525
  26. MDCalc. Charlson Comorbidity Index (CCI). MDCalc. Published 2021. Accessed December 7, 2021. https://www.mdcalc.com/charlson-comorbidity-index-cci
  27. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases. 2019;74(1):120-131. doi:10.1053/j.ajkd.2018.12.044
  28. Pugh D, Gallacher PJ, Dhaun N. Management of Hypertension in Chronic Kidney Disease. Drugs. 2019;79(4):365-379. doi:10.1007/s40265-019-1064-1
  29. Sinha AD, Agarwal R. Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD. CJASN. 2019;14(5):757-764. doi:10.2215/CJN.04330418
  30. Alicic RZ, Rooney MT, Tuttle KR. Diabetic Kidney Disease: Challenges, Progress, and Possibilities. CJASN. 2017;12(12):2032-2045. doi:10.2215/CJN.11491116
  31. Hahr AJ, Molitch ME. Management of Diabetes Mellitus in Patients With CKD: Core Curriculum 2022. American Journal of Kidney Diseases. Published online September 2021:S0272638621007629. doi:10.1053/j.ajkd.2021.05.023
  32. Segall L, Nistor I, Covic A. Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review. BioMed Research International. 2014;2014:1-21. doi:10.1155/2014/937398
  33. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation. 2021;143(11):1157-1172. doi:10.1161/CIRCULATIONAHA.120.050686
  34. Selim MFM, Lotfy EEM, Abd L, Mohamed E, Zahran MH. Assessment Of Erythropoietin Efficacy And Dosing In Hemodialysis Patients. European Journal of Molecular & Clinical Medicine. 2021;8(02):9.
  35. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713-735. doi:10.1053/j.ajkd.2014.01.416
  36. Wells BG, DiPiro JT, Schwinghammer TL, DiPiro CV. Pharmacotherapy Handbook.; 2015.
  37. Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016;316(19):2025. doi:10.1001/jama.2016.9185
  38. Yarnoff BO, Hoerger TJ, Simpson SA, et al. The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease. PLOS ONE. Published online 2016:14.



DOI: https://doi.org/10.22146/jmpf.72614

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