EXTON, Pa.—Nephrologists say that the new dialysis bundled payment has had the greatest impact on renal anemia management, according to a new report from BioTrends.
Approximately one-half of nephrologists surveyed perceive the new payment system as negative and feel significant pressure to target lower hemoglobin levels and to limit the measurement of non-essential labs, according to BioTrends, which surveyed more than 200 nephrologists in early March for its quarterly report “TreatmentTrends: US Nephrology.”
The hemoglobin level at which nephrologists initiate and hold erythropoietin stimulating agents (ESAs) in dialysis patients has declined compared to both the prior year and prior quarter and nephrologists expect this to ultimately result in fewer hemodialysis patients being treated with ESAs in the next six months, according to the BioTrends report.
Bundling also seems to be impacting ESA dosing frequency and method of administration, BioTrends reported. There have also been changes in the management of renal anemia in the chronic kidney disease non dialysis (CKD-ND) setting. Amgen’s Aranesp appears to be gaining momentum and is now the market leader among CKD-ND patients on ESAs and has a perceived competitive advantage compared to Centocor Ortho Biotech’s Procrit on a number of attributes. For the past several quarters, Procrit has suffered from declining monthly contact rates which seem to be impacting both product perception and, ultimately, market share.
Despite talks of increased use of intravenous (IV) iron in light of bundling, the percent of hemodialysis patients treated with IV iron has not changed, BioTrends found in the survey. Interestingly though, the most commonly cited recent change regarding IV iron in the dialysis setting is increased ferritin and transferrin saturation (TSAT) levels leading to more use of IV iron and fewer patients being placed on hold.
The survey also found that there have also been brand shifts in the hemodialysis IV iron market, which are particularly evident at the chain level. Market share for Fresenius’s Venofer has increased substantially compared to the prior year among nephrologists primarily affiliated with Fresenius units, share of Sanofi-Aventis’ Ferrlecit has increased substantially among nephrologists primarily affiliated with independent units, and share of AMAG’s Feraheme has decreased substantially among nephrologists primarily affiliated with small/medium dialysis organizations and independent units, where use of the product had been the greatest.
Nephrologists in the survey reported a high unmet need for a number of different conditions including acute kidney injury, diabetic nephropathy, lupus nephritis and hyperphosphatemia. They also report relatively high interest in a number of products in development including Reata / Abbott’s bardoxolone, HIF-PH inhibitors, Affymax / Takeda’s Hematide, and Rockwell’s Soluble Ferric Pyrophosphate, according to BioTrends.
