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For-Profit Dialysis Centers May Have Over-Used Epoetin

Patients with low hematocrit levels received three times as much epoetin at for-profit facilities

TUESDAY, April 17 (HealthDay News) -- End-stage renal disease patients treated at large, for-profit dialysis facilities may have received high amounts of red cell-boosting epoetin regardless of anemia status, according to a study published in the April 18 issue of the Journal of the American Medical Association. The U.S. Food and Drug Administration recently issued a warning recommending that the use of such erythropoiesis-stimulating agents be limited due to the potential risks of the drugs.

Mae Thamer, Ph.D., of the Medical Technology and Practice Patterns Institute in Bethesda, Md., and colleagues analyzed 2004 data from the U.S. Renal Data System on 159,522 Medicare-eligible patients, including 106,116 at large for-profit dialysis chain facilities and 28,199 at nonprofit dialysis facilities.

The researchers found that patients at for-profit facilities with hematocrit levels of less than 33 percent received three times the dosage of epoetin compared to their counterparts at nonprofit facilities. They also found that patients at for-profit facilities with hematocrit levels in the recommended 33 percent to 36 percent range received higher dosages of epoetin. The authors suggested that reimbursement policy and clinical performance measures may give for-profit facilities an incentive to target hematocrit levels exceeding those recommended by clinical guidelines.

"These discrepancies help to explain the explosion in the cost of epoetin therapy for dialysis patients," stated the author of an accompanying editorial. "Between 1998 and 2004, annual Medicare payments for erythropoiesis-stimulating agents (epoetin and darbepoetin) in patients with end-stage renal disease increased 115 percent from $840 million to $1.8 billion while patient volume increased just 33 percent."

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