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Journal de Pharmacie Clinique

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Cost-benefit analysis of neonatal anemia prevention with recombinant human erythropoietin in premature infants Volume 25, issue 3, Juillet-Août-Septembre 2006

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Unité de néonatologie, Hôpital des Enfants, 330, avenue de Grande-Bretagne, 31059 Toulouse Cedex 9, Service de pédiatrie, Centre hospitalier, 22, boulevard du Général Sibille, 81000 Albi, Service de pédiatrie, Centre hospitalier intercommunal, boulevard du Maréchal De Lattre De Tassigny, 65000 Tarbes

Premature infants frequently develop anemia. This is the result from blood sampling and from a relatively poor erythropoietic response to anemia. As a result, these infants often receive multiple transfusions with the risk of viral disease transmission. Aim: to determine the efficacy and cost-effectiveness of recombinant human erythropoietin (r-HuEPO) in reducing erythrocyte transfusion needs in preterm infants. Methods: 79 premature infants of less than 34 weeks gestationnal age and/or with a birth weight of less than 1 500 g were admitted in our unit from March 1998 to June 1999. They received r-HuEPO 750 U/kg/week intravenously or subcutaneously from day 10. These infants were compared to a retrospective cohort of 79 premature infants born during 1997 before introduction of the protocol r-HuEPO and matched for gestationnal age and for weight at birth. Results: hemoglobin upon admission, phlebotomy losses, clinical parameters were similar in both groups. The median number of transfusions per infant was 0 compared with 1 transfusion per control infant (p < 0.0001). Median volume of erythrocytes transfused was 0 (0-23,8 mL/kg) in r-HuEPO-treated infants and 27.38 (0-62,5 mL/kg) in control infants (p < 0.0001). The number of infant without transfusion was significantly higher in the r-HuEPO-treated group (54.5 versus 26.6 %; p < 0.0001). The cost per patient was 189 euros for r-HuEPO recipient and 284 euros for control infant. The effect of R-HuEPO was not significant for infants with gestational age more than 32 weeks or BW more than 1 200 g. Conclusion: R-HuEPO is cost-effective in the prevention of anemia of prematurity for children born before 32 weeks or with a BW less than 1 200 g. This treatment does not exclude other procedures to prevent transfusion requirements.