Annualized anemia treatment decision flowchart assumed in the CKD Policy Model.

<p>Annualized anemia treatment decision flowchart assumed in the CKD Policy Model.</p

Incremental cost-effectiveness as a function of anemia treatment targets in persons with CKD stages 3–4.

<p>Incremental cost-effectiveness as a function of anemia treatment targets in persons with CKD stages 3–4.</p

Lifetime risk of CKD, by baseline BMI category and highest CKD stage attained.

The difference in lifetime risk or any CKD between persons with obesity and normal weight was statistically significant at the 1% level. No other differences were statistically significant. Abbreviations: CKD = Chronic Kidney Disease, BMI = Body Mass Index.</p

Lifetime risk of any CKD, by baseline BMI category and age.

The difference in lifetime risk of any CKD between persons age 50–64 with obesity and normal weight was statistically significant at the 1% level. No other differences were statistically significant. Abbreviations: CKD = Chronic Kidney Disease, BMI = Body Mass Index.</p

Key parameters for probabilistic sensitivity analysis in the CKD Health Policy Model related to anemia, anemia treatment, complications of anemia and its treatment, and anemia treatment costs in persons with CKD stages 3 and 4.

<p>Key parameters for probabilistic sensitivity analysis in the CKD Health Policy Model related to anemia, anemia treatment, complications of anemia and its treatment, and anemia treatment costs in persons with CKD stages 3 and 4.</p

The Cost-Effectiveness of Anemia Treatment for Persons with Chronic Kidney Disease

<div><p>Background</p><p>Although major guidelines uniformly recommend iron supplementation and erythropoietin stimulating agents (ESAs) for managing chronic anemia in persons with chronic kidney disease (CKD), there are differences in the recommended hemoglobin (Hb) treatment target and no guidelines consider the costs or cost-effectiveness of treatment. In this study, we explored the most cost-effective Hb target for anemia treatment in persons with CKD stages 3–4.</p><p>Methods and Findings</p><p>The CKD Health Policy Model was populated with a synthetic cohort of persons over age 30 with prevalent CKD stages 3–4 (i.e., not on dialysis) and anemia created from the 1999–2010 National Health and Nutrition Examination Survey. Incremental cost-effectiveness ratios (ICERs), computed as incremental cost divided by incremental quality adjusted life years (QALYs), were assessed for Hb targets of 10 g/dl to 13 g/dl at 0.5 g/dl increments. Targeting a Hb of 10 g/dl resulted in an ICER of $32,111 compared with no treatment and targeting a Hb of 10.5 g/dl resulted in an ICER of$32,475 compared with a Hb target of 10 g/dl. QALYs increased to 4.63 for a Hb target of 10 g/dl and to 4.75 for a target of 10.5 g/dl or 11 g/dl. Any treatment target above 11 g/dl increased medical costs and decreased QALYs.</p><p>Conclusions</p><p>In persons over age 30 with CKD stages 3–4, anemia treatment is most cost-effective when targeting a Hb level of 10.5 g/dl. This study provides important information for framing guidelines related to treatment of anemia in persons with CKD.</p></div

Quality adjusted life years as a function of Hb treatment targets illustrates an inverted U-shaped relationship in persons with CKD stages 3–4.

<p>ESA, erythropoietin stimulating agents; Hb, hemoglobin.</p

One-way sensitivity analyses of cost-effectiveness for different anemia treatment targets.

<p>One-way sensitivity analyses of cost-effectiveness for different anemia treatment targets.</p

Cost-effectiveness acceptability curves from probabilistic sensitivity analysis of incremental cost-effectiveness for anemia treatment targets.

<p>Targets of 12.0 g/dl, 12.5 g/dl, and 13 g/dl never had the highest net benefit for any willingness to pay and therefore the corresponding curves equal the zero line.</p

Model parameters for relative risks related to obesity and annual change in BMI.

Model parameters for relative risks related to obesity and annual change in BMI.</p