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Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients.

N R Powe, R I Griffiths, A J Watson, G F Anderson, G de Lissovoy, J W Greer, R J Herbert, R A Milam and P K Whelton
JASN January 1994, 4 (7) 1455-1465; DOI: https://doi.org/10.1681/ASN.V471455
N R Powe
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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R I Griffiths
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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A J Watson
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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G F Anderson
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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G de Lissovoy
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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J W Greer
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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R J Herbert
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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R A Milam
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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P K Whelton
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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Abstract

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.

  • Copyright © 1994 by American Society of Nephrology
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Journal of the American Society of Nephrology
Vol. 4, Issue 7
1 Jan 1994
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Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients.
N R Powe, R I Griffiths, A J Watson, G F Anderson, G de Lissovoy, J W Greer, R J Herbert, R A Milam, P K Whelton
JASN Jan 1994, 4 (7) 1455-1465; DOI: 10.1681/ASN.V471455

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Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients.
N R Powe, R I Griffiths, A J Watson, G F Anderson, G de Lissovoy, J W Greer, R J Herbert, R A Milam, P K Whelton
JASN Jan 1994, 4 (7) 1455-1465; DOI: 10.1681/ASN.V471455
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