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Recombinant erythropoietin and Medicare payment
J E Sisk1, F D Gianfrancesco, J M Coster
1Office of Technology Assessment, US Congress, Washington, DC.
JAMA
|July 10, 1991
Summary
Federal Medicare policies significantly impact medical technology use and cost. For recombinant erythropoietin, payment incentives led to low doses and suboptimal anemia correction in dialysis patients.
Area of Science:
- Nephrology
- Health Policy
- Biotechnology
Background:
- Recombinant human erythropoietin (EPO) treats anemia in chronic kidney disease patients.
- Medicare is the primary payer for EPO in the US, covering most dialysis patients.
- Federal payment policies can influence the adoption and cost of medical technologies.
Purpose of the Study:
- To examine the influence of Medicare payment policies on the utilization and cost of recombinant EPO.
- To assess the impact of fixed payment rates on EPO dosing and patient response.
Main Methods:
- Analysis of Medicare's payment structure for recombinant EPO.
- Review of EPO dosage and patient hematocrit levels in Medicare beneficiaries.
- Evaluation of financial incentives for dialysis facilities.
Main Results:
- Medicare's predominant payer status contributed to a low US price for recombinant EPO.
- Fixed payment rates created incentives for dialysis facilities to use lower EPO doses.
- Fewer than 45% of long-term treated patients achieved target hematocrit levels by August 1990.
Conclusions:
- Medicare payment policies for recombinant EPO created financial incentives for underdosing.
- Routine monitoring of patient response is necessary to ensure quality of care.
- Federal policies must consider the interplay between payment incentives and clinical outcomes.