Cost analysis of erythropoietin versus blood transfusions for cervical cancer patients receiving chemoradiotherapy.
OBJECTIVE
Red blood cell (RBC) transfusions or erythropoietin (EPO) can be used to evade the detrimental effects of anemia during radiotherapy, but the economic consequences of selecting either intervention are not well defined. The RBC transfusion needs during chemoradiotherapy for cervix cancer were quantified to allow comparison of RBC transfusion costs with the projected cost of EPO in this setting.


METHODS
For patients receiving pelvic radiotherapy, weekly cisplatin, and brachytherapy, the RBC units transfused during treatment were tallied. RBC transfusion costs per unit included the blood itself, laboratory fees, and expected value (risk multiplied by cost) of transfusion-related viral illness. EPO costs included the drug itself and supplemental RBC transfusions when hemoglobin was not adequately maintained. An EPO dosage based on reported usage in cervix cancer patients was applied.


RESULTS
Transfusions were given for hemoglobin <10 g/dL. Among 12 consecutive patients, 10 needed at least 1 U of RBC before or during treatment, most commonly after the fifth week. A total of 37 U was given during treatment, for an average of 3.1 U/patient. The sum total of the projected average transfusion-related costs was $990, compared with the total projected EPO-related costs of $3869.


CONCLUSIONS
Because no proven clinical advantage has been documented for EPO compared with RBC transfusions to maintain hemoglobin during cervix cancer treatment, for most patients, transfusions are an appropriate and appealingly less expensive option.
Kavanagh
B D
BD
Department of Radiation Oncology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia, USA.
Fischer
B A
BA
Segreti
E M
EM
Wheelock
J B
JB
Boardman
C
C
Roseff
S D
SD
Cardinale
R M
RM
Benedict
S H
SH
Goram
A L
AL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001918:Brachytherapy / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D003365:Costs and Cost Analysis; D017707:Erythrocyte Transfusion / Q000191:economics*; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000635:transmission; D006509:Hepatitis B / Q000191:economics / Q000635:transmission; D006526:Hepatitis C / Q000191:economics / Q000635:transmission; D006801:Humans; D008875:Middle Aged; D011336:Probability; D011838:Radiation-Sensitizing Agents / Q000009:adverse effects; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy*
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D004921:Erythropoietin; D002945:Cisplatin