Subcutaneous Injections Of Epogen Could Save Medicare $537M

[okarol]

MEDICAL NEWS TODAY

Use Of Subcutaneous Injections Of Epogen For Dialysis Patients Could Save Medicare $537M Annually
26 Oct 2006   

Administering the anti-anemia drug Epogen to kidney dialysis patients by subcutaneous injections rather than intravenously could save the federal government hundreds of millions of dollars annually, the Boston Globe reports. Epogen, which is manufactured by California-based Amgen, is administered to kidney disease patients on dialysis to replenish red blood cells. About 95% of the 325,000 U.S. residents on dialysis receive Epogen intravenously, although studies have found that about 30% less Epogen is required if the drug is injected under the skin, the Globe reports. Medicare spends close to $2 billion per year on Epogen, more than on any other drug. According to a study conducted by researchers at Detroit-based Henry Ford Hospital and published in the American Journal of Kidney Disease, administering Epogen subcutaneously rather than intravenously would save the federal government as much as $537 million annually. The study found that the annual Epogen cost per dialysis patient in 2002 was $6,000. Researchers determined that switching to subcutaneous injections would save up to 30%, or $1,761, per patient. A separate study of dialysis clinics in 2004 found that patients received 21% less Epogen when given subcutaneous injections, the Globe reports. Last year, FDA allowed Amgen to change the label on Epogen to state that intravenous delivery is preferred because of a rare disorder called pure red cell aplasia that developed in 175 patients from 1998 through 2003. Those patients received Eprex, a drug similar to Epogen that is manufactured by a Johnson & Johnson subsidiary. J&J said the cases likely were linked to rubber stoppers in some of its syringes and that the outbreak ended after the stoppers were replaced.

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California-based DaVita and Germany-based Fresenius Medical Care, the two leading dialysis clinic chains in the U.S., have said they prefer to administer Epogen intravenously because patients already have IVs inserted while they undergo dialysis, according to the Globe. DaVita chief medical officer Charles McAllister said, "We don't have any opinion on subcutaneous or intravenous" methods, adding that doctors at the company's clinics determine the best way to give Epogen. Fresenius did not comment. Robert Brenner, an Amgen medical director, said, "It is important for patients and physicians to make their own decisions," adding, "Where patients are hooked up to a blood line to a dialysis machine, there would be some logic to have that administration occur intravenously, as opposed to having that patient exposed to an additional injection." Some kidney specialists and patient advocates say DaVita and Fresenius use the intravenous method to boost profits. Noshi Ishak, a kidney specialist who owns an independent dialysis clinic in New Hampshire, said DaVita and Fresenius "give it intravenously" to "milk the system." Ishak, who uses the subcutaneous method, said Amgen sales representatives have told him that he could increase his profits by administering the drug intravenously. Peter Crooks, who oversees dialysis of 3,000 patients for Kaiser Permanente in Southern California, said, "The industry is incentivized to use intravenous because they make a profit margin on every unit they administer," adding, " Many dialysis facilities feel that if it wasn't for the profit margin they make on [Epogen], they would go out of business" (Rowland, Boston Globe, 10/24).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=55007

[livecam]

Kaiser was insisting on subcue EPO back in 1999 when I was first on dialysis.  The only problem with going subcue is that it hurts where normally most patients just have it injected into the tubing already in place during a treatment session.  I never really understood why they wanted it delivered that way but the article explains it well.

[Rerun]

We just ALL need to stop taking it and then the drug company would be back peddling the price to where it is reasonable. 

We don't HAVE to have EPO we just do better with it.

[livecam]

I hope you are just pulling our legs Rerun.  I remember the days before I was on EPO very well.  Life was extremely tough then.  I was weak, shivering constantly, just wavering around all the time and trying to maintain a full time job, a family life etc.  It was hell on earth.  EPO is a major blessing.

[Rerun]

It is a blessing, but at the cost we could boycot it for a month.  That would do the drug company in.  That is how things work supply and demand....but you know that.

[livecam]

How come we can't buy it from Canada?  Oops the government won't allow that...might cutin to someone's excessive profits.

[Rerun]

I'm not willing to get another shot three times a week or even once a week.  Those shots hurt like hell!  I use to get them once a month when I had my transplant.......only it was called Procrit.  My arm would hurt for five minutes.  That doesn't sound very bad, but let me remind you I Don't Like Pain!   

[jbeany]

The shots hurt the most if they don't warm the darn stuff up.  (You have to store it in the fridge.)  I've been doing mine at home sub cu for 10 years.  I'm on Aranesp now, which has fewer side effects than Procrit (the baseball-bat-in-a-bottle drug, because you feel like you've been beaten by one the day after you take it), but I think the Aranesp injections hurt less, too.

We don't HAVE to have EPO we just do better with it.

That might be true for some, rerun, but my kidneys don't make any erythropoietin at all, and haven't for years.  My hemoglobin was below 6 when they started me on it, and would likely have kept dropping.  I actually fell asleep in the middle of my doctor's appointment before he prescribed the lovely stuff.  (He answered an emergency phone call while I was in the room with him, and he had to shake me awake.)  I had so few red blood cells that they did a bone marrow test for leukemia. (Now that's a really painful needle - with sound effects when they slam it thru the bone in your hip.)

I think I'd rather keep taking it sub cu - why mess up my dosage now?

[Rerun]

Well......there was a time......not too long ago when we didn't have EPO and if your hbc dropped below a certain level you got a blood transfusion.  I'm not saying that we are better off without the stuff, I'm just saying that if we didn't take it for awhile the price would come down.  The drug companies "think" they have us over a barrel and so the price is high.

Just like people who think they would die without a cell phone.  We lived fine without them a few years ago.

[AlasdairUK]

I inject Arenesp EPO once a week. It is the smallest needle and it hardly hurts compared to the value you get out of it. I'm more than happy to inject.

[mallory]

I inject Aranesp once a week, also.  It is a tiny needle, it really doesn't hurt.  And I feel so much better, it's been a miracle for me.  It is very expensive, my insurance covers most of it, but they told me the retail price was $1100.00 an injection.  What would people do who didn't have insurance?  Very few people would even make enough money to pay for the injections, they'd never have enough money to live on.

[kitkatz]

No more needles! Hard enough to get me to get the vaccinations they insist that I have. One more needle in the other arm each week will put me over the edge! Plus 6000 of Epo is a lot put into your tissue in one site on the arm.

[Ohio Buckeye]

wow, I get 20,000 each shot.  Sometimes I've had 2 shots per wk.
now 1 every 10 days.  plus iv iron injections sometimes.
I haven't got up the courage to give them to myself.  I have a friend
who is a nurse give them to me.  I just can't bring myself to give myself
a shot. 

[Jill D.]

Before I started dialysis, I had to inject Procrit once or twice a week at home. It was nothing I Iooked forward to, but it sure made me feel better. I had a choice to inject in my leg or my stomach - I chose my stomach (more fat there!) and it didn't hurt too much, although I always had bruises at the injection site. I definitely prefer not to have any more needle sticks now that I have started hemodialysis. I think there are A LOT of people making lots of money on this.
It really worries me when I see how much Medicare spends on this...

[Zach]

When I've taken it, I've stuck it in my belly.  Like an insulin shot.  And remember, there are higher concentrations available, so you may be talking about 0.2 cc.

[kitkatz]

All I know is the last time they gave me Procrit in hospital it hurt like hell!  They also gave me heparin shots to thin blood and I would not let them do it in the belly, I made them do it in the arm. I had a big black and blue spot on my arm or two weeks after a six day stay for an angiogram.  I have also had Epogen given to me in my arm.  Ouch!!! Anything that painful, forget it! When the nurse who gives it, does it first with the real stuff, then okay I might do it. But then I might just cackle evilly and make them do it in the lines anyway!

[BigSky]

Most of the people here are given Aranesp every two weeks.

[paris]

I get Arenesp every 2 weeks and use a self testing blood kit to check hemoglobin in between if I start feeling like the level is dropping. I was barely functioning before the shots and will gladly have some pain(the shot does burn like crazy going in) for the difference it has made in my life.  My insurance bill shows my dosage costing $1750.  Thank goodness for insurance and also for the researchers developing new drugs. The iron infusions make me sick for days after. Vomiting every day, but then I feel so much better for a couple of months.  Bring it on--I will try anything to feel better.