Objective. Evaluation of the clinical and economic effectiveness of the use of epoetin alfa or roxadustat in combination with iron supplements in adult patients with anemia due to chronic kidney disease (CKD) on dialysis in the Russian healthcare system.
Material and methods. Comparative review of the clinical effectiveness and safety of the use of epoetin alfa with calculation of direct medical costs was performed; pharmacoeconomic model to assess the relationship between the use of epoetin alfa or roxadustat and the financial costs of therapy for CKD patients with anemia was developed; cost-effectiveness analysis and budget impact analysis were conducted.
Results. An analysis of the literature showed that the use of roxadustat in CKD patients with anemia leads to a more rapid and significant increase in hemoglobin (Hb) levels with a lower iron requirement compared to the use of epoetin alfa. However, roxadustat also has a higher incidence of adverse events (AEs) and serious AEs (SAEs). Direct medical costs for a course of epoetin alfa per patient per year (RUB 200,792.25) were lower than for a course of roxadustat (RUB 273,653.2), with different costs of treating complications (RUB 7,597.51 and RUB 18,325.05, respectively). According to the cost-effectiveness analysis, the advantage remained with the course of epoetin alfa, the cost-effectiveness coefficients for which were: RUB 237,905.51. per year per patient who responded to therapy, and 85,081.46 rubles. per year for an increase in Hb level by 1 g/dL. For roxadustat, these values amounted to 310,264.4 rubles. per year and 106,479.84 rubles. per year accordingly. Thus, when choosing epoetin alfa, the savings will be RUB 72,358.89. or RUB 21,398.38 taking into account the response to therapy or increase in Hb level, respectively. Sensitivity analysis demonstrated the stability of the developed model to an increase in the cost of a course of epoetin alfa to +30%, a decrease in the proportion of patients who responded to a course of epoetin alfa to 23%, and decline in Hb level during treatment with epoetin alfa to 20%. The budget impact analysis showed that, with a possible cohort size of 47,000 people, increasing the proportion of patients receiving epoetin alfa from 70 to 90% while reducing the proportion of patients receiving roxadustat from 30 to 10% would reduce budget costs by RUB 684,892,928 ,64 per year. This will allow an additional 3,411 CKD patients on program hemodialysis with anemia to be treated with epoetin alfa per year (+7.25%).
Conclusion. The results of the work showed that the use of epoetin along with standard iron therapy in adult CKD patients with anemia on program hemodialysis and not previously treated with erythropoiesis-stimulating agents is clinically effective and economically preferable therapy within the Russian healthcare system.

Keywords: epoetin alfa, roxadustat, erythropoiesis-stimulating agents, program hemodialysis, chronic kidney disease