Anemia drugs may be overused
For-profit dialysis chains treating the bulk of kidney disease patients in the U.S. are more aggressive in using lucrative anemia drugs compared with their nonprofit peers, a study released Tuesday said.
The Journal of the American Medical Assn. study compared prescribing patterns at nonprofits versus big corporate chains and found that doctors at chains gave patients bigger increases and total doses of epoetin.
Epoetin boosts oxygen-transporting hemoglobin in red blood cells of kidney disease patients, who are prone to low red blood cell counts.
The anemia medication, a man-made version of the natural protein erythropoietin, is sold by Thousand Oaks-based Amgen Inc. as Epogen.
Medicare, the health insurance plan for 43 million elderly and disabled in the U.S., spends about $1.8 billion on epoetin, its biggest single drug expense.
The journal report comes on top of recent findings that doses of the drugs that are higher than recommended boost the risk of death and serious heart problems. U.S. regulators last month ordered a “black box” warning on the drugs, highlighting these risks and advising doctors to use the lowest effective dose.
“What surprised us the most is how certain chains and providers clearly were targeting [red blood cell levels] outside the U.S. Food and Drug Administration label,” said Mae Thamer, the lead author on the paper and a researcher at the Medical Technology and Practice Patterns Institute in Bethesda, Md.
The recommended levels at the time of the study were to keep patients’ blood composed of 33% to 36% red blood cells, known as the hematocrit level.
The recommended levels have since increased, but experts last week proposed dropping them again amid the safety concerns.
The study of patient records for 160,000 severely ill kidney disease patients’ records found that in about a quarter of the cases involving for-profit chains, patients had a hematocrit level of 39% or higher. About 80% of patients studied were treated by for-profit companies.
Once patients were in the recommended hematocrit level, nonprofits dropped doses of epoetin, while the for-profit chains kept increasing doses, the study found.
Patients with kidney failure need regular dialysis to clear their blood of wastes. Anemia, a shortage of red blood cells, is a common side effect of the disease and can cause fatigue and headaches.
The study didn’t name the chains involved, but El Segundo-based DaVita Inc. and Germany’s Fresenius Medical Care are the two biggest for-profit dialysis chains and control at least two-thirds of the U.S. market, according to analysts.
The chains get at least a quarter of their income from profit from the anemia drugs, the study’s authors and analysts said.
LeAnne Zumwalt, DaVita’s spokeswoman, said Medicare wouldn’t reimburse the company for exceptionally high hematocrit levels among its patients, which is a built-in financial incentive to keep their levels within the target range.
