Estimation of peginesatide utilization requires patient-level data

Abstract

Post hoc analysis of two Phase 3 pivotal trials (EMERALD 1,2) of peginesatide vs epoetin for anemia due to chronic kidney disease in hemodialysis patients on stable epoetin showed that for increasing doses of baseline epoetin, relatively less peginesatide was needed to achieve similar Hb levels (Fishbane et al, ASN 2011). Estimation of peginesatide should therefore be dictated by underlying epoetin dose distribution rather than total volume or mean epoetin dose in a population. This analysis compared estimated peginesatide utilization for facilities using comparable levels of epoetin. Eight facilities from a large dialysis organization whose epoetin utilization was within ±1% of median utilization across all facilities from Q4 2011 were compared. The label-specified dose conversion table was used to convert weekly epoetin dose (defined using all pt-months with ≥1 dose) to monthly peginesatide dose for each facility Comparison of total epoetin use (Q4 2011) from the 8 facilities showed relative differences of <2% (range, 6.4-6.5M U). Facility utilization of post-conversion peginesatide was estimated to range from 668-901 mg, representing relative differences of up to 35% (Figure) In contrast, calculations based on mean epoetin doses resulted in 41-184% overestimation of peginesatide use. Due to the nonlinear dose relationship between peginesatide and epoetin, facilities with similar epoetin use (<2% relative difference) had up to 35% difference in estimate of peginesatide use. For accurate estimation of peginesatide utilization, it is important to base conversions on epoetin dose distribution rather than mean epoetin dose.fx1