Meta-analysis And Economic Study Of Roxadustat In The Treatment Of Renal Associated Anemia In Dialysis Patients

Objectives:The efficacy and safety of roxadustat and erythropoietin in the treatment of renal anemia in patients with dialysis-dependent chronic kidney disease were meta-analyzed,which combined with relevant domestic studies and clinical conditions of renal anemia to provide evidence for further strengthening the treatment and management of anemia.On the basis of drugs recommended by domestic and foreign guidelines for treatment of renal anemia,from the perspective of China’s medical and health system,this paper applies Markov model to analyze the pharmacoeconomics of renal anemia in China,in order to provide safer,more effective and economical treatment strategies for clinical treatment,optimize drug treatment schemes,improve the overall utilization efficiency of medical resources and reduce the medical burden.Methods:1.Search Pubmed,Embase,Cochrane Library,Web of Science,CBM、Wan Fang,VIP and CNKI databases until June 2022.Randomized controlled trials(RCTs)of roxadustat and Erythropoietin(EPO)in the treatment of renal anemia in dialysis patients with chronic kidney disease were collected.Two researchers screened the literature,and obtained the change data of hemoglobin(Hb),transferrin saturation,ferritin,iron regulatory protein,total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)before and after treatment.The heterogeneity of this study was evaluated by Q test and I~2test.When the heterogeneity was large,the random effects model was used for data analysis,otherwise,the fixed effects model was used.The dichotomous variables were expressed by relative risk(RR)and 95%CI,and the continuity variables were expressed by mean difference(MD)and 95%CI.2.Based on Markov model,according to the estimated cost data of a tertiary hospital in Yunnan Province,the results of four RCTs at home and abroad are used as the curative effect index.Treeage Pro 2011 software was used to simulate the quality-adjusted life years(QALYs)and cost of using roxadustat and EPO to treat renal anemia in dialysis-dependent patients during 10 years,and the cost-effectiveness of roxadustat and EPO was analyzed.Sensitivity analysis of the research variables was also carried out.Results:1.Meta-analysis results:A total of 27 articles and 6197 patients were involved.Compared with EPO,roxadustat increased Hb level,and the effect of improving Hb level was faster and more stable than EPO(MD=0.90,95%CI:0.70-1.10,P<0.001),with statistical significance.For the improvement of iron metabolism in vivo,roxadustat increased the saturation of transferrin(MD=0.04,95%CI:0.02-0.06)and serum iron(MD=3.00,95%CI:1.61-4.39),and the effect of reducing iron regulatory protein was better than EPO(MD=-23.05,95%CI:-29.34～-16.76),P<0.0001,the difference was statistically significant.There was no statistical difference between the two drugs for the increased ferritin(MD=9.97,95%CI:-18.53～38.46,P=0.49).In terms of lipid metabolism,TC level in roxadustat group was decreased by 0.71mmol/L(MD=-0.71,95%CI:-0.88～-0.53,P<0.0001),LDL-C level in roxadustat group was decreased by 0.58mmol/L(MD=-0.58,95%CI:-0.79～-0.37,P<0.0001),the decreasing trend was more obvious than EPO group,the difference was statistically significant.In terms of clinical safety,ADR of roxadustat group was 1.02 times higher than that of EPO group(MD=1.02,95%CI:0.90-1.15,p=0.78),and there was no statistical difference,which indicated that the safety of the two drugs was comparable.The funnel chart is used to test publication bias.Funnel chart is basically symmetrical and there is no significant publication bias.2.The results of Markov model in economics suggest that from the perspective of domestic health system,the current WTP incremental analysis is 3*GDP,which is173,100 yuan.Compared with EPO group,the cost-effectiveness analysis of roxadustat group is 124,409 yuan,and roxadustat group can make anemia patients get higher quality of life.Although the price is higher,the added cost is acceptable and it is an economical option for patients with dialysis-dependent chronic renal disease anemia.Moreover,with the increase of GDP,WTP or the decrease of the drug cost of roxadustat,the advantages of roxadustat group compared with EPO group will be more obvious.Conclusions:1.Compared with erythropoietin,roxadustat can significantly increase Hb levels of dialysis-dependent CKD patients,improve anemia,and have positive clinical benefits for dyslipidemia and some iron metabolism;2.The economic results suggest that from the perspective of health system in China,roxadustat can improve the quality of life of anemia patients,and it is an economic scheme worthy of clinical use and research for dialysis-dependent CKD anemia patients.