What are cancer patients willing to pay for prophylactic epoetin alfa? A cost-benefit analysis.
BACKGROUND
Anemia, one of the most common complications of cancer chemotherapy, has been managed with red blood cell (RBC) transfusions. As an alternative, the agent epoetin alfa has the potential to reduce the transfusion requirements of patients receiving cancer chemotherapy. To estimate the value that cancer patients place on the drug, an economic analysis using the concept of willingness to pay (WTP) was conducted.


METHODS
The method of WTP was used within the framework of a classical cost-benefit analysis to estimate the net cost or benefit of administering prophylactic epoetin alfa to cancer patients. This estimate included the direct cost of epoetin alfa administration and savings secondary to reduced RBC transfusions. A cohort of 100 cancer patients who received or were scheduled to receive cisplatin or noncisplatin chemotherapy (50 per group) were then interviewed to measure the maximum WTP (net benefit) that they experienced with epoetin alfa.


RESULTS
Regarding the benefits they would experience after 3 months of epoetin alfa administration, patients receiving cisplatin and noncisplatin therapy stated that they would be willing to pay an average of 587 U.S. dollars (U.S.$587) (95%CI: $300-$875) and U.S.$613 (95%CI: $324-$902), respectively. These benefits were then subtracted from the total cost of the drug when administered to patients receiving cisplatin (U.S.$3530) and noncisplatin (U.S.$3653) therapy. This produced a net incremental treatment cost of U.S.$2943 (95%CI: $2655-$3230) and U.S.$3039 (95%CI: $2750-$3328) for the respective treatment groups.


CONCLUSIONS
The results of the current study suggest that the routine administration of epoetin alfa to cancer patients receiving myelosuppressive chemotherapy is a highly resource-intensive treatment policy with modest benefit to patients. Additional research is required to identify high risk patient subgroups who would benefit most from the drug. [See editorial on pages 2427-9, this issue.]
Ortega
A
A
Department of Pharmaceutical Services, Princess Margaret Hospital, Toronto, Ontario, Canada.
Dranitsaris
G
G
Puodziunas
A L
AL
D000740:Anemia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D000970:Antineoplastic Agents / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D000068817:Epoetin Alfa; D017707:Erythrocyte Transfusion / Q000191:economics; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics*; D006397:Hematinics / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007182:Income; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy*; D011306:Prescription Fees; D011994:Recombinant Proteins; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors
D000970:Antineoplastic Agents; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D002945:Cisplatin