Recombinant human erythropoietin usage in a large academic medical center

Recombinant human erythropoeitin (rhEPO) is a highly effective but expensive drug used for the treatment of certain anemias. We considered opportunities to curtail inpatient rhEPO utilization in light of therapeutic alternatives, the drug's delayed onset of action, and the available literature.

A retrospective review of rhEPO administration in a large academic medical center between February and June 2000 was conducted by using administrative databases.

The computerized inpatient pharmacy transaction file of the Hospital of the University of Pennsylvania was queried to determine trends for rhEPO administration. We then employed CaduCIS (CareScience, Philadelphia, PA) to determine the clinical diagnoses and resources used for each inpatient receiving rhEPO.

In the study period, 248 inpatients received at least 1 rhEPO dose. More than 100 different physicians, representing 20 departments and divisions, ordered approximately 17 million units of rhEPO. Hematology/Oncology accounted for 33% of all units ordered, and Surgery and General Medicine ordered 16% and 14%, respectively. The usual length of stay for patients receiving rhEPO varied considerably: 34% of patients remained in hospital for < or = 7 days, while 31% remained > or = 3 weeks. As many as 34% of patients began rhEPO therapy as inpatients. Of inpatients receiving rhEPO, only 49% met labeled indications for rhEPO administration.

At our institution, approximately one half of all inpatient rhEPO usage is for an off-label indication. Utilization patterns may suggest strategies for conserving this scarce resource.