Prior to 2002, ESAs were primarily administered by the subcutaneous route of administration, due to lower dose requirements and thus cost savings for epoetin alfa. However, in 2002 the subcutaneous route of epoetin alfa in chronic kidney disease was contraindicated due to an increase in the incidence of cases of anti-Epo antibody medicated pure red cell aplasia (PRCA) associated with subcutaneous use of the product between 1998 and 2002. Since then the majority of hemodialysis patients in Australia have been treated with ESAs by the intravenous route of administration. Recently the manufacturers identified the probable cause of increased immunogenicity of epoetin alfa and corrected for it (Boven et al 2005). Consequently, the TGA reinstated the use of subcutaneous epoetin alfa in chronic kidney disease patients in mid-2005 (240th ADEC Meeting Recommendations, June 2005). By converting hemodialysis patients back to subcutaneous ESA administration this may lead to considerable cost-savings: for every 100 patients on 11,200IU epoetin a week (current Australian average) this would be a savings of over $110 000-330 000 per year based on 10-30% dose reduction.