Due to the increased emphasis on cost-containment, drugs must be proven not only to be safe and effective, but also to reduce costs, prior to be used in clinical practice. In the context of this saving policy, 12 clinically stable patients on hemodialysis who were administered darbepoetin-alpha (Aranesp (DARB) for at least 16 months in single weekly doses, were converted to EPO-alpha, administered 2-3 times per week. The initial dose of EPO-alpha was calculated on the basis of a dose-conversion ratio (DCR) of 200 IU EPO-alpha = 1 mcg DARB. The mean Hb value in the six months preceding the conversion was between 11 and 12 g/dL, with a monthly dose of DARB unchanged/ reduced during the last three months. During the last month of treatment with DARB, the mean Hb value of the cohort was 11.4+/-0.5 g/dL and the mean weekly dose per patient was 24 +/- 12 mcg. After two months of EPO-alpha use, the mean Hb value dropped to 10.8+/-0.7 g/dL, with a mean monthly dose per patient of 5.667+/-2.229 IU, corresponding to a DCR of 234. In order to bring the Hb values back to above 11 g/dL, doses of EPO-alpha were progressively increased up to a maximum of 10.000+/-5.461 IU per patient, corresponding to a DCR of 414. The attempt to convert 12 hemodialysis patients treated with darbepoetin-alpha to an ESA with an apparent lower cost resulted in a worsening of the anemia of the patients after the conversion. Instead of leading to savings, the conversion actually increased expenditures.