The economic burden of anemia in cancer patients receiving chemotherapy.
BACKGROUND
Anemia is one of the most common hematologic complications of cancer and cytotoxic treatment. The economic burden associated with anemia in patients with malignancy has not yet been extensively studied.


METHODS
Patients receiving chemotherapy within 6 months of initial cancer diagnosis were identified in a database of commercial health-care service claims and encounters. Patients with anemia were identified through a coded diagnosis of anemia, transfusion, or erythropoietin treatment. Exponential conditional mean models and a decomposition analysis were used to analyze mean 6-month health-care expenditures.


RESULTS
Twenty-six percent (26%) of 2760 cancer patients with recently diagnosed invasive cancer treated with chemotherapy had anemia. Mean (SD) 6-month unadjusted total expenditures were 62,499 dollars (78,016 dollars) for anemic patients and 36,871 dollars (52,308 dollars) for nonanemic patients (P < 0.0001), with inpatient services representing the largest cost differential between the groups. The adjusted mean 6-month expenditure for the average anemic patient receiving chemotherapy was 57,209 dollars. If anemic patients had the same average health status as nonanemic patients, their predicted 6-month expenditures would have been 19% lower (46,237 dollars). Alternatively, if anemic patients had the same expenditure structure or parameter estimates as nonanemic patients, their predicted expenditures would have been 51% lower (27,847 dollars). Thus, for any given health status, treating a patient who is anemic is associated with considerably higher expenditures.


CONCLUSIONS
Anemia among cancer patients receiving chemotherapy is associated with a substantial burden in terms of direct medical costs. Implications for the treatment of anemia are suggested by this research and should be confirmed in prospective studies.
Lyman
Gary H
GH
University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Gary_Lyman@urmc.rochester.edu
Berndt
Ernst R
ER
Kallich
Joel D
JD
Erder
M Haim
MH
Crown
William H
WH
Long
Stacey R
SR
Lee
Howard
H
Song
Xue
X
Finkelstein
Stan N
SN
D000368:Aged; D000740:Anemia / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D017281:Cost of Illness; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D006278:Medicare; D016345:Medicare Part B; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D017063:Outcome Assessment, Health Care; D011994:Recombinant Proteins; D012189:Retrospective Studies; D014481:United States
D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D004921:Erythropoietin