The costs and benefits of the use of erythropoietin in the treatment of anaemia arising from chronic renal failure: a European study

The purpose of this study was to estimate the costs and benefits of the use of erythropoietin (EPO) in the treatment of anaemia arising from chronic renal failure. Recurrent dialysis of chronic renal failure (CRF) patients results in their haemoglobin being depleted and the patient becoming listless and weak. The conventional method of mitigating these effects is blood transfusion at regular intervals. Recombinant human erythropoietin (EPO) maintains the haemoglobin of CRF patients at a satisfactory level, avoids the adverse effects of haemoglobin depletion on the patients’ quality of life, and removes the risks associated with transfusions. These obvious benefits can only be achieved using the new and expensive drug. However, some resources are saved as blood transfusions are no longer necessary for patients treated with EPO. To evaluate the costs and benefits of the use of EPO for CRF patients, a five nation study was funded by Emron Inc. (USDA) and managed from the Centre for Health Economics at The University of York, England. An identical research protocol was used by research groups in Italy, France, Spain and Germany and the UK to identify the costs if the use of EPO, the resource savings generated by such a treatment and the effects of this treatment on the patients’ quality of life. The impact on patients’ quality of life was measured using the Rosser matrix of disability-distress states. The movement between health states in response to the treatment was assessed using expert opinions of nephrologists and a limited amount of patient self-assessment. The results of the study in the five countries are reported in this paper and show that the use of EPO produces patient benefits at significant cost. Obviously, with such a new technology the cost-outcome (QALY) characteristics of the treatment may change as dosage rates are adjusted to patient responses. However, it seems at present that the use of EPO for patients with end stage renal failure is a high cost way of producing patient benefits, measured in terms of quality adjusted life years (QALYs).