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Abeer K. Jumaa*, Hassan M. Abbas Al Temimi, Ali A. Dyab Allawi, May S. Alsabbagh and Kawther Faris


Background: Renal anemia is the decrease in one or more of the major red blood cell measurements; concentration of hemoglobin, hematocrit, or red blood cell count. Impaired ability of the kidneys to secrete erythropoietin and consequent reduction in the erythrocytes production was the major cause of anemia. Objective: The aim of the study was to assess the cost-effectiveness of methoxy polyethylene glycol-epoetin β versus epoetin alfa in the treatment of hemodialysis patients with renal anemia Methods: A prospective single centerrandomized- controlled-open labeled clinical trial with three months treatment and follow up periods was performed. Forty six Patients with renal anemia were randomly allocated to receive either MPG-EPO 100μg once every two week or epoetin alfa 4000 IU twice per week subcutaneously and were evaluated at baseline and monthly during the followed up period. Blood sample of patients groups were evaluated for Hb, PCV, Reticulocyte count, serum ferritin, iron, total iron binding capacity. Monitoring of the adverse effects of methoxy poly-ethylene glycol epoetin beta and epoetin alpha was done either by clinical examination for the objective data or by questionnaire for the subjective data. Cost analysis was done taking into account the direct drug acquisition cost only, the cost result was the difference in patients per month cost with MPG-EPO versus epoetin alfa. Results: Hemoglobin concentration, reticulocyte count and packed cell volume were significantly increased with MPG-EPO and epoetin alfa. Mean change of Hb was 1.53±1.04 g/dl for MPG-EPO versus 1.41±0.96 g/dl for epoetin alfa. The rise in haematological parameters in methoxy polyethylene glycol-epoetin beta group was non significantly higher than that of epoetin alfa groups. One case of arteriovenous fistula thrombosis and local pain after S.C injection was reported in MPG-EPO arm. Other adverse events and complications include flu-like symptoms, diarrhea and blood transfusion was reported in both arms of study. There were no cases of hypertension, nasopharyngitis, upper respiratory tract infection, rash and hot flushes were reported for both MPG-EPO and epoetin alfa and no death reported during the study. The patient/month cost was 292£ for MPG-EPO and 190£ for epoetin alfa, with a difference of 102 £. Conclusion: Methoxy polyethylene glycol epoetin beta provided comparable effect on hematological parameter to that of epoetin alfa in patients with renal anemia. Methoxy polyethylene glycol epoetin beta had a good safety profile that comparable to epoetin alfa and it is well tolerated in renal anemia. Treatment with MPG-EPO has led to an increase of 102 £ in the patient/month cost

Keywords: methoxy polyethylene glycol-epoetin beta, end-stage renal disease, anemia, epoetin alfa, cost.

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