Erythropoietic therapy for the treatment of anemia in patients with cancer: a valuable clinical and economic option.
BACKGROUND
Healthcare organizations must evaluate the cost effectiveness of the alternative therapies that are available to treat anemia and improve quality of life (QoL) of patients with cancer, that is, erythropoietic protein therapy and blood transfusion.


METHODS
Pharmacoeconomic studies that evaluated the cost of not treating anemia or treating with transfusion or erythropoietic protein therapy were reviewed and compared. Studies of individual erythropoietic proteins (epoetin alfa, epoetin beta or darbepoetin alfa) were also assessed. As no prospective trials have compared the erythropoietic proteins, retrospective studies and the results of separate trials were analyzed. The database searched for this review was PubMed (open date to August 2006). Recent conference abstracts were also searched (2003-July 2006).


RESULTS
There is a high cost associated with anemia in cancer patients. Treatment of anemia is likely to lead to increased hemoglobin (Hb) levels and improved QoL as principal outcomes. Therefore, in assessing erythropoietic protein versus transfusion, it is more appropriate to use Hb or QoL as endpoint rather than quality adjusted life year. Studies with the former approach showed that erythropoietic protein therapy is more cost effective than transfusion. Also, its cost effectiveness should be improved with the use of evidence-based guidelines for patient selection and more tailored utilization. Increasing evidence suggests there might be differences among the erythropoietic proteins in terms of response rate, speed of response, and need for dose escalation.


CONCLUSIONS
Significant costs are incurred when anemia in cancer is not treated. Erythropoietic protein therapy is more cost effective than blood transfusion for the treatment of cancer-related anemia. Transfusion should be reserved for patients with poor responses to erythropoietic protein or for the emergency setting, when rapid improvement in Hb is required.
Cornes
Paul
P
Bristol Haematology & Oncology Centre, Horfield Road, Bristol, UK. paul.cornes@ubht.nhs.uk
Coiffier
Bertrand
B
Zambrowski
Jean-Jacques
JJ
D000041:Absenteeism; D000740:Anemia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000628:therapy; D001803:Blood Transfusion / Q000191:economics; D002017:Budgets; D003362:Cost-Benefit Analysis; D000068256:Darbepoetin alfa; D016527:Drug Costs; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000191:economics / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins; D016896:Treatment Outcome
D006454:Hemoglobins; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D007501:Iron