Use of erythropoietin in cancer patients: assessment of oncologists' practice patterns in the United States and other countries.
OBJECTIVE
To assess physician use of erythropoietin in cancer patients before publication of the American Society of Clinical Oncology/American Society of Hematology guidelines.


METHODS
Questionnaires about erythropoietin use in practice and 12 hypothetical clinical scenarios involving patients with cancer were mailed to 2000 oncologists/hematologists in the United States and 19 other countries. Response rates were 30% in the United States and 25% internationally. Data on erythropoietin use for ovarian cancer were obtained from one clinical trial. Multivariate regression models assessed predictors of erythropoietin prescription.


RESULTS
Most physicians selected a hemoglobin level < or =10 g/dL as an upper threshold for erythropoietin use (36% to 51% of U.S. physicians and 21% to 32% of foreign physicians). Frequent erythropoietin use (defined as use in at least 10% of cancer patients) was higher in the United States than elsewhere (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.5 to 13.4). Among U.S. physicians, those who said they used erythropoietin frequently were more likely to be in fee-for-service than managed care settings (OR = 2.2; 95% CI: 1.3 to 3.7). Those who reported never using erythropoietin practiced in countries that had lower annual per capita health care expenditures, lower proportions of privately funded health care, and a national health service (P <0.05 for all comparisons). Of 235 ovarian cancer patients who received topotecan, 38% (45/118) of U.S. patients and 2% (2/117) of European patients who developed grade 1 anemia (hemoglobin level between 10 and 12 g/dL) were treated with erythropoietin (P <0.01).


CONCLUSIONS
Financial considerations and a hemoglobin level <10 g/dL appear to influence erythropoietin use in the United States, whereas financial considerations alone determine erythropoietin use abroad.
Adams
Jared R
JR
Department of Veterans Affairs, the MidWest Center for Health Services and Policy Research and the Veterans Affairs Chicago Healthcare System/Lakeside Division, Chicago, Illinois, USA.
Elting
Linda S
LS
Lyman
Gary H
GH
George
James N
JN
Lembersky
Barry C
BC
Armitage
James O
JO
Demetri
George D
GD
Bennett
Charles L
CL
D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016001:Confidence Intervals; D017046:Cost Savings / Q000706:statistics & numerical data; D003431:Cross-Cultural Comparison; D004363:Drug Utilization / Q000706:statistics & numerical data; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use*; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006452:Hemoglobinometry / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data; D008495:Medical Oncology / Q000191:economics / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000191:economics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012044:Regression Analysis; D019772:Topotecan / Q000009:adverse effects / Q000627:therapeutic use; D014481:United States
D000970:Antineoplastic Agents; D004921:Erythropoietin; D019772:Topotecan