JAPAN SEES EPO DOSE REDUCTION WITH BUNDLING

http://www.renalbusiness.com/news/2010/10/japan-sees-epo-dose-reduction-with-bundling.aspx

Renal Business Today

JAPAN SEES EPO DOSE REDUCTION WITH BUNDLING

BRUSSELS, Belgium—More than four years after Japan implemented a payment policy that bundled erythropoietin-stimulating agents with dialysis, the country has seen a reduction in ESA use and an increase in the prescription of intravenous iron, according to an article published online Oct. 20 in Kidney International.
In Japan, everyone is required to have health insurance, either through work or a community-based insurer. Those too poor to get coverage have their tabs picked up by the government.

In April 2006, Japan's health system implemented a bundling policy that included recombinant human erythropoietin (rHuEPO) in outpatient hemodialysis therapy, according to the study.

In order to understand the effects of this policy, the researchers analyzed a prospective cohort of hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study. In all, the study followed 53 facilities and 1,584 patients before the policy change and 1,622 patients after the policy change.

Patient data included hemoglobin levels, iron management profiles, and anemia treatment with EPO and intravenous iron, according to the study.

The researchers reported that they found no significant differences in pre- or post-policy cross-sections for hemoglobin distributions or the percentage of patients prescribed EPO.

The mean dose of EPO decreased by 11.8 percent, according to the research. In addition, the percentage of patients prescribed intravenous iron over 4 months significantly increased; however, the mean dose of iron did not significantly change.

“Thus, this bundling policy was associated with reduced rHuEPO doses, increased intravenous iron use, and stable hemoglobin levels in Japanese patients receiving hemodialysis,” the researchers concluded.