Cost-minimization analysis of once-weekly versus thrice-weekly epoetin alfa for chemotherapy-related anemia.
BACKGROUND
For individuals with chemotherapy-related anemia, the clinical effectiveness of epoetin alfa (EPO) dosed once weekly ([QW], 40,000 units per dose) has been demonstrated to be indistinguishable from that observed with thrice-weekly dosing ([TIW], 10,000 units per dose). Whether the advantage of less-frequent administration justifies the higher EPO dosage used in the weekly regimen in terms of overall cost of care is unknown.


OBJECTIVE
To conduct a cost-minimization analysis comparing QW and TIW EPO dosing from a societal perspective.


METHODS
Direct and indirect medical cost data were calculated for a 16-week period for 2 large, prospective, multicenter, community-based studies. Costs measured included EPO, transfusions, laboratory tests, office visits, and opportunity cost of patient time.


RESULTS
The average total costs in 2002 (first half) dollars were nearly equivalent across the 2 groups (QW: 9,204 dollars; 95% confidence interval [CI], 9,057 dollars-9,350 dollars. TIW: 9,265 dollars; 95% CI, 9,083 dollars-9,447 dollars. P=0.60). QW incurred mean drug acquisition costs that were 23% higher (QW: 6,725 dollars; 95% CI, 6,611 dollars-6,838 dollars. TIW: 5,474 dollars; 95% CI, 5,350 dollars-5,598 dollars. P<0.001). However, QW patients can avoid the resource use and time cost associated with 2 additional office visits incurred each week (QW: 592 dollars [583 dollars-600 dollars]; TIW: 1,709 dollars [1,678 dollars-1,740 dollars]; P<0.001). Transfusion and laboratory test costs were slightly higher in the TIW group (QW: 1,888 dollars [1,837 dollars-1,940 dollars]; TIW: 2,082 dollars [2,020 dollars-2,144 dollars]; P<0.001).


CONCLUSIONS
Total anemia treatment costs over a 16-week period with EPO QW were similar to those of TIW dosing. In the absence of cost differences between regimens, the noneconomic advantages of less-frequent dosing intervals should make weekly dosing increasingly attractive to patients, clinicians, and payers.
Crémieux
Pierre Y
PY
Analysis Group, Inc., 111 Huntington Ave., Tenth Fl., Boston, MA 02199-7636, USA. pcremieux@analysisgroup.com
Fastenau
John M
JM
Kosicki
George
G
Piech
Catherine T
CT
Fendrick
A Mark
AM
D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001803:Blood Transfusion / Q000191:economics; D003363:Cost Control; D003365:Costs and Cost Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage* / Q000191:economics*; D005260:Female; D006403:Hematologic Tests / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D011446:Prospective Studies; D011994:Recombinant Proteins
D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa