The Cost Effectiveness of XXXX -Stimulating Agents for Treating @entity417 in @entity1 on Dialysis: A Systematic Review.

@entity177 @entity1 @entity1307 @entity417
UNASSIGNED: Background: @entity417 is a common complication associated with @entity177 and is marked by poor health and increased risk of morbidity and mortality. There are ongoing concerns with the use of @entity1307 Stimulating Agents (ESAs) to treat @entity417 in @entity1 with @entity177 on dialysis. Questions as to their benefits, harms and overall effect on quality of life are still relevant today. Our objective was to systematically review studies evaluating the cost-effectiveness of ESAs in @entity1 with @entity177 on dialysis. Methods: We performed a systematic review of studies determining the cost-effectiveness of ESAs in adult @entity1 on dialysis. Databases, including PubMed, EMBASE, and Cochrane Database of Systematic Reviews, were searched from their establishment until June 2013. Studies that reported an incremental cost-effectiveness ratio of hemoglobin correction strategies based on ESA treatments in comparison to red blood cell transfusions, lower hemoglobin targets, or no ESA treatment were included. Results: Seven studies met inclusion criteria. Reported cost/quality-adjusted life-year (QALY) ratios ranged from USD 931-677,749/QALY across five studies comparing ESAs to red blood cell transfusions. There was heterogeneity in results when considering higher hemoglobin targets, with studies finding higher targets to be both dominant and dominated. Mortality, hospitalization, and utility estimates were major drivers. Conclusions: There is substantial variability in the estimates of the cost-effectiveness of using ESAs in the dialysis population. New models incorporating recent meta-analyses for estimates of utility, mortality, and hospitalization changes would allow for a more comprehensive answer to this question.    2015 S. Karger AG, Basel.
