title: The impact of anaemia and its treatment on employee disability and medical costs.
abstract: OBJECTIVE
  Anaemia is a common haematological complication of cancer and cytotoxic treatment. The incremental economic burden associated with medical care and short-term disability of anaemia in patients with malignancy and receiving chemotherapy has not been well documented. This study evaluates the effect of anaemia on the costs associated with cancer treated with chemotherapy.
  
  
  METHODS
  Patients receiving chemotherapy within 6 months of their initial cancer diagnosis were identified in a commercial claims database for 1999-2000. Data for these individuals were linked to their employers' short-term disability records via unique encrypted personal identification numbers provided by employers. Patients with anaemia were identified by a diagnosis of anaemia or treatment with transfusion or erythropoietin alfa (EPO). Healthcare expenditure and short-term disability leave were observed for up to 6 months following initial cancer diagnosis and were summarised into monthly averages. Exponential conditional mean models and zero-inflated negative binomial models were used to analyse mean monthly healthcare expenditures and short-term disability days.
  
  
  RESULTS
  Twenty-five percent of the 619 newly diagnosed cancer patients treated with chemotherapy had anaemia. The presence of anaemia and longer length of transfusion therapy were associated with increased expenditures, while longer length of EPO treatment was associated with lower expenditures. The incremental costs due to anaemia among patients receiving chemotherapy were US$5,538 (year 2001 values) per month in the first 6 months following cancer diagnosis, 10.8% of which were costs related to short-term disability leave.
  
  
  CONCLUSIONS
  Anaemia in patients undergoing chemotherapy presents a substantial burden to employers and payers. The findings also suggest that patients with anaemia treated with erythropoietin alfa can achieve expenditure levels similar to those patients without anaemia.
authors.affiliation: Alfred P. Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA. ebrendt@mit.edu
authors.forename: Ernst
authors.initials: E
authors.lastname: Berndt
authors.forename: William
authors.initials: W
authors.lastname: Crown
authors.forename: Joel
authors.initials: J
authors.lastname: Kallich
authors.forename: Stacey
authors.initials: S
authors.lastname: Long
authors.forename: Xue
authors.initials: X
authors.lastname: Song
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000191:economics*; D017281:Cost of Illness; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin