Abstract
As the Japanese population has been aging, the number of chronic hemodialysis (HD) patients per physician/nurse and the severity of HD patients’ disease have been increasing. To further confound the situation, as erythropoiesis-stimulating agents (ESA) are now included in the Diagnosis Procedure Combination/Per-Diem Payment System (DPC/PDPS), there has been an increasing focus on reducing ESA-associated costs. Thus, we healthcare practitioners are called on to ensure patient safety and provide quality care, while at the same time managing stress among health practitioners and keeping hospital operations financially viable. Against this background, we conducted a cohort study involving a total of 27 HD patients who were converted from darbepoetin (DA) to epoetin kappa (EPOκ), a less expensive option, and investigated the impact of the increase in the dosing frequency (from 2 twice monthly to up to 3 times weekly) associated with this conversion on the mental stress experienced by medical staff, the incidence of medical accidents/incidents, and economic costs. The differences in the biological activity of the two ESA were also examined. No significant change in the mental stress experienced by the staff was seen after the conversion from DA to EPOκ (as evaluated by the New Brief Job Stress Questionnaire), despite the associated increase in dosing frequency. Likewise, there was no significant increase in the incidence of injection-related medical accidents/incidents after the conversion. The conversion also led to an impressive 46.3% reduction in monthly ESA-related costs. Furthermore, a longitudinal study did not detect a significant difference in the biological activity of the two ESA. Given the paucity of information regarding the efficacy of long-acting versus short-acting ESA, caution needs to be exercised when choosing among the currently available ESA.
