title: Routine once-weekly darbepoetin alfa administration is cost-effective in lung cancer patients with chemotherapy-induced anemia: a Markov analysis.
abstract: BACKGROUND
  Despite the clinical efficacy of recombinant human erythropoietin (RHE) on chemotherapy-induced anemia, most cost-effectiveness studies have given unfavorable results.
  
  
  OBJECTIVE
  To determine the cost of managing anemia in unselected patients receiving chemotherapy for lung cancer, and the efficacy and cost-effectiveness of RHE.
  
  
  METHODS
  We constructed Markov models of two cohorts of patients who received (n=94) or did not receive (n=89) darbepoetin (one weekly injection when the hemoglobin level fell below 11 g/dl), focusing on changes in hemoglobin levels, transfusion requirements, anemia management costs, and the cost-effectiveness ratios of the two management strategies.
  
  
  RESULTS
  The use of RHE significantly reduced the proportion of patients needing transfusions (from 33.6% to 19.1%, p<0.05) and the number of red cell units used by transfusion (from 2.97+/-1.47 to 2.11+/-0.47, p<0.01). Markov modeling showed that the RHE strategy significantly increased the mean Hb level (13+/-0.5 g/dl versus 11.9+/-1g/dl, p<0.001), at the price of an increase in the main cost (respectively, US$ 1732+/-897 and 996+/-643; p<0.01). The cost-effectiveness ratio favored the RHE strategy (7.02 versus 9.04). Sensitivity analysis showed that the RHE strategy remained dominant in most situations.
  
  
  CONCLUSIONS
  Routine use of RHE appears to be cost-effective in patients receiving chemotherapy for lung cancer.
authors.affiliation: Department of Pharmacy, Hôpital Saint Antoine, AP-HP, 75012 Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Borget
authors.forename: Patrick
authors.initials: P
authors.lastname: Tilleul
authors.forename: Mariette
authors.initials: M
authors.lastname: Baud
authors.forename: Anne Christine
authors.initials: AC
authors.lastname: Joly
authors.forename: Anne
authors.initials: A
authors.lastname: Daguenel
authors.forename: Christos
authors.initials: C
authors.lastname: Chouaid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D000068256:Darbepoetin alfa; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents; D004921:Erythropoietin; D000068256:Darbepoetin alfa