Health economic evaluation of treating anemia in cancer patients receiving chemotherapy: a study in Belgian hospitals.
BACKGROUND
Erythropoiesis-stimulating agents (ESAs) are used in chemotherapy-induced anemia (CIA) with the goal of improving quality of life and preventing RBC transfusions. This retrospective database study compared the three currently available ESAs, epoetin alfa (EPO-A), epoetin beta (EPO-B), and darbepoetin alfa (DARB), regarding costs and outcomes.


METHODS
Data were obtained from a Belgian longitudinal database, including medical and financial data on cancer patients receiving chemotherapy and ESAs, submitted by 46 Belgian hospitals. Propensity score matching was applied to correct for selection bias. The main effectiveness parameter was defined as transfusion- and anemia-readmission-free survival (TA-free survival) at 3 months. Costs were analyzed taking the health care payer perspective.


RESULTS
Including 1,584 EPO-A, 380 EPO-B, and 429 DARB propensity-matched patients, TA-free survival rates were similar for the three groups (DARB, 84.37%; EPO-A, 84.60%; EPO-B, 84.94%). Overall inpatient costs were euro 16,949 +/- euro 1,025, euro 19,472 +/- euro 901, and euro 19,295 +/- euro 1,048 for DARB, EPO-A, and EPO-B, respectively (DARB versus EPO-A, p < .0001 and DARB versus EPO-B, p = .008). Anemia-associated costs were euro 3,051 +/- euro 218 in the DARB group, compared with euro 3,995 +/- euro144 for EPO-A (p < .0001) and euro 3,752 +/- euro 229 for EPO-B (p = .0132).


CONCLUSIONS
To our knowledge, this is the first real-life matched retrospective study comparing ESAs with regard to both costs and effects. For similar patient profiles, the patients in the DARB group consumed the smallest amounts of ESAs, with similar clinical outcomes. These data therefore suggest a greater efficiency of DARB in the treatment of CIA.
Spaepen
Erik
E
IMS Health, Brussels, Belgium. ESpaepen@be.imshealth.com
Demarteau
Nadia
N
Van Belle
Simon
S
Annemans
Lieven
L
D000368:Aged; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001530:Belgium; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D006397:Hematinics; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa