Supplementary Material for: Cost Savings Using a Protocol Approach to Manage Anemia in a Hemodialysis Unit

<b><i>Background:</i></b> National guidelines recommend using anemia management protocols to guide treatment. The objective of this study was to determine if an anemia management protocol would improve hemoglobin (Hgb) indices in hemodialysis patients and to measure whether the protocol would reduce the use and cost of darbepoetin alfa (DBO) and intravenous (IV) iron in hemodialysis patients. <b><i>Methods:</i></b> An anemia management protocol was created and implemented for hemodialysis patients at our institution. A retrospective observational review of the use of DBO and IV iron as well as changes in Hgb, transferrin saturation and ferritin in 174 patients was conducted 6 months before and after implementation of the anemia protocol. <b><i>Results:</i></b> The number of Hgb measurements in the target range increased from 44.3 to 46.0% (p = 0.48) after protocol implementation. The mean weekly dose of DBO was reduced from 34.56 ± 31.12 to 31.11 ± 28.64 μg post-protocol implementation (p = 0.011), which translated to a cost savings of USD 41,649 over 6 months. The mean monthly IV iron dose also decreased from 139.56 ± 98.83 to 97.65 ± 79.05 mg (p &lt; 0.005), a cost savings of USD 18,594 over the same time period. <b><i>Conclusion:</i></b> The use of an anemia management protocol resulted in the deprescribing of DBO and iron agents while increasing the number of patients in the target Hgb range, which led to significant cost savings in the treatment of anemia.

<b><i>背景：</i></b> 国家临床指南推荐采用贫血管理方案指导诊疗工作。本研究旨在评估贫血管理方案能否改善血液透析患者的血红蛋白（hemoglobin, Hgb）水平，并探究该方案是否可降低血液透析患者对达依泊汀α（darbepoetin alfa, DBO）与静脉铁剂（intravenous iron, IV iron）的使用量及相关成本。<b><i>方法：</i></b> 本机构为血液透析患者制定并实施了一项贫血管理方案。研究对174例患者在该方案实施前后各6个月内的达依泊汀α与静脉铁剂使用情况，以及血红蛋白、转铁蛋白饱和度和铁蛋白的变化开展了回顾性观察性研究。<b><i>结果：</i></b> 方案实施后，血红蛋白水平处于目标范围内的检测人次占比从44.3%升至46.0%（p=0.48）。达依泊汀α的周均剂量从34.56±31.12 μg降至31.11±28.64 μg（p=0.011），据此计算6个月内可节省医疗成本41649美元。静脉铁剂的月均剂量也从139.56±98.83 mg降至97.65±79.05 mg（p<0.005），同期可节省医疗成本18594美元。<b><i>结论：</i></b> 采用贫血管理方案可在提升血红蛋白水平达标患者占比的同时，减少达依泊汀α与铁剂的使用量，进而为贫血治疗带来显著的成本节约。