P88
ERYTHROPOIETIN STIMULATING AGENT CONVERSION FROM MIRCERA® TO
EPREX® AT ILKESTON SATELLITE DIALYSIS UNIT: A RETROSPECTIVE
SERVICE EVALUATION
Dring, B, Hall, M
Nottingham Renal and Transplant Unit, NUH NHS Trust
INTRODUCTION: Anaemia management is a key component of the management of patients
receiving renal replacement therapy. In July 2011, patients at Ilkeston dialysis unit established
on monthly intravenous methoxy-ethylene glycol-epoietin beta (Mircera®) were electively
converted to 3 times weekly intravenous epoetin alfa (Eprex®). In this evaluation we report the
impact of conversion on quality targets and cost over 12 months.
AIMS: To evaluate the impact of the ESA conversion on haemoglobin target attained, iron
indices and intravenous iron requirements, estimated biological ESA dosage and estimated cost
of ESA administration.
METHODS: Data was collected retrospectively on 29 patients from computerised records from
3 months prior to the conversion and 12 months afterwards. Parameters included: age, gender,
weight, ESA dose, haemoglobin, ferritin, transferring saturation, peak C-reactive protein, peak
parathyroid hormone, intravenous iron dose, urea reduction ratio and vascular access.
Continuous parametric variables were compared between 3-monthly periods by one way
analysis of variance (ANOVA) with post-hoc analysis using the Bonferroni method. Non
parametric continuous variables were compared using the Kruskal-Wallis test. Categorical
variables were compared by Pearson Chi-squared test and linear by linear association for trend.
A p value of <0.05 was used to define statistical significance.
RESULTS: 29 patients (48.3% female) were included in the service evaluation.
Mean haemoglobin and the proportion achieving target haemoglobin did not differ significantly
following ESA conversion. Use of intravenous iron and indices of iron status were unchanged
following ESA conversion. Parathyroid hormone and C-reactive protein levels were also
unchanged following ESA conversion. The proportion of patients outside of the target
haemoglobin range did not significantly change following conversion from monthly to thrice
weekly administration. ESA doses were compared between Mircera and Eprex by defining
doses as low, medium and high dose (Table 1).The proportion of patients receiving high dose
ESA reduced over the study period from 15 to 8, with a reciprocal change in the proportion of
patients receiving low dose therapy increasing from 7 to 14. The number on a medium dose
remained stable, at around 7 (p=0.04). Despite an increase in nursing time required to
administer thrice weekly ESA vs monthly ESA (38 minutes 48 seconds/patient/month vs 3
minutes 56 secs /patient/month), the reduction in high dose ESA requirement led to an overall
cost reduction of £165/patient/quarter (based on British National Formulary list prices).
Table 1: Definitions of low, medium and high dose ESA.
Low dose
Medium dose
High dose
Eprex (per week)
<8,000iu
8,000 -<15,000iu
>15,000iu
Mircera (per month)
<100mcg
100 - <200mcg
>200mcg
CONCLUSION: Conversion from Mircera to Eprex in a cohort of patients receiving
haemodialysis was not associated with a significant change in haemoglobin, achievement of
haemoglobin targets, changes in intravenous iron use or indices of iron status. Based on
nationally published costs for Mircera, Eprex and nursing time, conversion from Mircera to
Eprex led to a reduction in quarterly costs of approximately £165 per patient.