| Summary: | 碩士 === 義守大學 === 管理研究所碩士班 === 96 === Anemia is one of the common problems among patients with chronic kidney disease, and one of the important parameters of dialysis quality measurement. Artificially synthesized erythropoietin (Recombinant human Erythropoietin, rHuEPO) can treat the renal anemia effectively, reduce the need of blood transfusion, and improve the life quality of patients. rHuEPO has been widely used for approximately 20 years. Darbepoetin alfa, an improvement type of erythropoietin with marked long–acting effect, not only provides the same efficacy and safety as other rHuEPO, but also reduces the frequency of drug administration. This study enrolled 66 regular and long–term hemodialysis patients at a teaching hospital in southern Taiwan. With a treatment target of hematocrit / hemoglobin 33~36%/11~12 g/dL, the goals of this study were to compare the medical costs between patients treated with rHuEPO–beta and Darbepoetin alfa, to compare their influence in clinical biochemistry data, and to analyze the possible related factors.
Using quasi–experimental design, this study selected long–term hemodialysis patients in a teaching hospital with a purposive sampling technique. With a matched control method (the matched factors were hematocrit and age), totally 66 patients were divided into two groups with a ratio of 1:2 according to the uses of Darbepoetin alfa or rHuEPO-beta. An observation period for 9 months was performed. All the patients received regular erythropoietin and intravenous iron therapy according to a fixed protocol for the targets of hematocrit around 33~36% and serum Ferritin 200~400 ng/ml, respectively. SPSS 12.0 was used for statistical analyses, which included description statistics, Mann–Whitney U test and Chi–square test.
The study results showed no significant difference on hematocrit and hemoglobin between the uses of Darbepoetin alfa and rHuEPO–beta in the 9–month study period. There was also no significant difference in iron status and biochemistry data. In addition, the results indicated that the medical costs (including the costs of erythropoietin, iron supplements, and blood transfusion treatment) were not significantly different between the study groups. However, the treatment protocol with Darbepoetin alfa did consume NT﹩142/month more than that of rHuEPO-beta among patients of a standardized weight on 70kg. The results can provide meaningful references to nephrologists and hospital administrators for decision making on treatment and policy.
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