A Survey of Medical Nephrologists and Interviews with Payers
Chronic kidney disease (CKD) and its underlying conditions (diabetes and hypertension) are among the top causes of disability-adjusted life years in the Latin American region. Complications arising from CKD include renal anemia and mineral disorders such as hyperphosphatemia and secondary hyperparathyroidism that significantly increase the costs of treating CKD as the disease progresses. Hence, new, cost-effective drug treatments that can delay the progression of CKD are in high demand. Although several erythropoiesis-stimulating agents (ESAs) have been approved in Brazil and Mexico to treat renal anemia, access barriers to more recent and effective ESAs limit the majority of patients in the public sector to domestically produced ESA products. In addition, public CKD patients must meet strict requirements to be eligible for ESAs and other CKD therapies that are managed by nephrologists. In the private sector, a different access environment develops, but barriers still exist in both countries. All of these access barriers have created a need for oral drugs with new mechanisms of action, such as hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors (for example, roxadustat by AstraZeneca/FibroGen) and iron-based phosphate binders such as Velphoro and Auryxia.