Analisi costo-efficacia di darbepoetina dopo switch da epoietina-beta nei pazienti in emodialisi: studio retrospettivo monocentrico italiano

Darbepoietin (DARB), a human erythropoietin with improved pharmacological parameters (longer half life and a dose-responsible relationship independent from the route of administration) is a new treatment option for chronic nephropathy-induced anemia that in many Italian dialysis centers is substituting older erythropoietins, version factor, DARB pharmaceutical costrangers from – 9% to 17% of EPO cost. In this monocentric study real drug consumption and related actual costs of a pre-switch semester with EPO were analysed and compared to the first two post-swtich with DARB therapy. Furthermore, erythropoietin response was recorded and related to drug exposition levels, in order to establish a real life EPO:DARB dose conversion factor. In this experience, the conversion factor was estimated in at least 250-280:1, depending on the method adopted for the estimation. The initial dose chosen on the basis of the recommended conversion factor induced an excessive erythropoietic response, which was generally followed by a dose reductionand successive titration to target desired HB levels, generating the spiraliform dose-response curve associatd with delayed feed-back mechanisms. The pharmacoeconomical analysis conducted in the perspective of the public health service, indicated that the choice of substituting DARB for EPO in yhe treatment of chronic kidney failure associated anemia is univocally convenient, the former being less costly and more effective.