A forthcoming article to be published in the July 2006 issue of the American Journal of Kidney Diseases finds that physician decision-making for the delivery of epoetin therapy is primarily influenced by the type of ownership and financial incentives associated with dialysis centers.
The study, Factors Influencing the Route of Administration for Epoetin Treatment Among Hemodialysis Patients in the United States, was conducted by authors from MTPPI and from the Boston VA. Thamer et al. concluded that given the similar effectiveness but significantly reduced dose associated with subcutaneous (SC) epoetin, this study suggests an enormous opportunity for cost-savings for the Medicare program.
All current guidelines, including the U.S.-generated National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) and the European and Canadian national guidelines for anemia management, recommend SC administration for hemodialysis patients based on best evidence. However, in the U.S. only 7% of all hemodialysis patients receive epoetin via SC route with important implications in terms of the dose, frequency of administration, costs, and, potentially, outcomes. Despite this disparity between the recommended guidelines and real world practice, few studies have examined the factors associated with route of administration of epoetin therapy among hemodialysis patients.