Erythropoietin Outcomes Assessment: Linking Clinical and Economic Parameters
Bibliographic record
Abstract
ABSTRACT Human recombinant erythropoietin (Epo) is a mainstay in the treatment of patients with anemia of chronic renal failure (CRF), decreasing transfusions and improving the quality of life of patients who receive it. While Phase III trial-based cost-effectiveness studies have demonstrated the economic viability of prescribing Epo, post-marketing surveys which link drug utilization with clinical and economic outcomes are absent. A retrospective assessment of Epo therapy was conducted in 68 hemodialysis patients. Clinical and economic outcomes were assessed to determine Epo's impact on health status and resource utilization. Overall, Epo increased hematocrit (Hct) and hemoglobin (Hgb) levels by an average of 25.1 % and 24.4%, respectively. The mean (± standard deviation, (SD)) absolute Hct and Hgb levels achieved were 0.284 ± 0.04 and 96.3 ± 14.1 g/L, respectively, based on a mean Epo dose of 40.5 ± 21.1 units/kg three times per week (3x/wk). Dosing requirements were also assessed in selected patient subgroups. The overall average Epo dose in patients with pre-existing hypertension (HTN) was 1l.9 units (35.2%) more per kg 3x/wk than those with no underlying HTN. In patients without preexisting HTN who then developed this condition, the average Epo dose was 12.1 units (42.8%) more per kg 3x/wk than in those patients who did not exhibit new onset HTN. Considering drug costs and savings due to avoided transfusions and hospitalization, the total additional cost of Epo therapy from the perspective of the institution was $888 per patient per year. Thus, Epo improves hematologic indices in patients with CRF-induced anemia al an additional cost. Patients with HTN may require a different Epo dosing regimen, a previously unreported phenomenon which deserves further investigation. RESUME L'erythopoietine recombinee humaine (Epo) est une pierre angulaire dans le traitement de l'anemie due a l’insuffisance renale chronique (IRC). Elle permet de diminuer le nombre de transfusions et d'ameliorer la qualite de vie des patients qui en recoivent. Bien que des etudes cout-efficacite dans le cadre d'essais de phase III aient demontre la viabilite economique de l'administration de l'Epo, il n’y a toujours aucune etude post-commercialisation d'entreprise sur la relation entre l'utilisation du medicament et les resultats economiques et cliniques. Une evaluation retrospective du traitement a l'Epo a ete menee aupres de 68 patients hemodialyses. Les resultats cliniques et economiques ont ete evalues pour determiner l'impact de l'Epo sur l'etat de sante des patients et sur l'utilisation des ressources. Dans l'ensemble, l'Epo a accru les taux d’hematocrite (Hct) et d'hemoglobine (Hgb) en moyenne dc 25, l % et de 24,4 % respectivement. Les moyennes (± ecart-type de la moyenne (ET)) des taux absolus d'Hct et d'Hgb qui ont ete atteints etaient de 0,284 ± 0,04 et de 96,3 ± 14,1 g/L respectivement, en se fondant sur une dose moyenne d'Epo de 40,5 ± 21,1 unites/hg administree trois fois par semaine (3 f.p.s.). Le schema posologiquc a aussi ete evalue chez des sous-groupes de patients choisis. La dose moyenne globale d'Epo chez les patients presentant deja une hypertension arterielle (HTA) etait de 11,9 unites (32,5 %) de plus par kg 3 f.p.s. que chez les patients ne presentaient aucun antecedent d'HTA. Les patients qui ne presentaient aucun antecedent d'HTA et qui ont developpe spontanement cette affection ont recu une dose moyenne d'Epo de 12,1 unites (42,8 %) de plus par kg 3 f.p.s. que ceux qui n’ont montre aucun signe d'HTA. En tenant compte des couts des medicaments et des economies engendrees par l'evitement de transfusions et d'hospitalisations, le cout supplementaire total du traitement a l'Epo, du point de vue de l'etablissement, etait de 888 $ par patient par annee. Par consequent, l'Epo ameliore les indices hematologiques chez les patients ayant une anemie attribuable a l'IRC a un cout additionnel. Les patients hypertendus peuvent necessiter un schema posologique de l'Epo different, une observation qui n’a jamais ete rapportee jusqu’ici et qui merite de recherches plus poussees.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".