Impact analysis of the less frequent dosing of Erythropoiesis Stimulating Agents in chronic haemodialysis patients and process optimisation in 2 Canadian hospitals

10 september 2019

After the success of the Mercurius study in 40 European dialysis centres, this study was also conducted in 2 Canadian hospitals (Toronto General Hospital and Grand River Hospital).

Expertise: cost impact study

Project Highlights

Customer: Amgen Canada

Main Goal: Determine the qualitative and quantitative impact of less frequent dosing of ESAs in chronic HD patients, and strengthen the partnership of Amgen Canada with 2 key accounts by performing process analyses and improvements for these participating hospitals

Main Result: Report on the impact of less frequent dosing for these 2 hospitals (incl. scientific poster), process optimization recommendations for both hospitals and strengthening the partnership between Amgen and the 2 Canadian hospitals

The objective of the study in Canada:

  • mapping of the quantitative and qualitative impact of the less frequent dosing of ESA's in chronic haemodialysis patients compared to other ESA's;
  • a profound analysis of the processes - directly or indirectly – linked to ESA and recommendations for the optimisation of these processes.


For this analysis an impact model (geared to the Canadian market) was developed, consisting of a conceptual model, a generic model and a hospital-specific model:

  • The conceptual model describes the three dimensions of this impact analysis: organisation, processes and activities.
  • The generic model forms the basis of research and describes the standard processes, activities and functions that are part of the flow of an ESA injection throughout the hospital.
  • The entire flow of the ESA injection was followed throughout each individual hospital and hospital-specific data were collected, to result in hospital-specific models. A calculation model was also developed to calculate the impact of the less frequent dosing of ESA's on the costs of the individual hospitals. The qualitative impact was defined by means of structured interviews and observations at the hospitals. At the same time recommendations were elaborated for the optimisation of the processes in 2 Canadian hospitals.

Process Flow for Erythropoiesis Stimulating Agents (ESA) Delivery to Haemodialysis (HD) Patients at Toronto General Hospital Process Optimization & Impact Analysis of Alternative Dosing Frequencies

See Poster


  • General confirmation of the significant cost savings by the less frequent dosing of ESA
  • Definition of the qualitative advantages for each participating hospital
  • Publication of these results during the yearly conference of The Canadian Society of Hospital Pharmacy
  • Optimisation of the pharmacy processes, stocks, back office processes, distribution of medicinal products, quality, etc. through structured analyses
  • Recommendations, best practices and benchmarks for the 2 hospitals
  • Consolidation of the commercial position of Aranesp® at the Grand River Hospital and Toronto General Hospital (UHN)
  • Development of a solid partnership between Amgen and the 2 Canadian hospitals