Economic evaluation of erythropoiesis-stimulating agents for anemia related to cancer.
BACKGROUND
Erythropoiesis-stimulating agents (ESA) administered to cancer patients with anemia reduce the need for blood transfusions and improve quality-of-life (QOL). Concerns about toxicity have led to more restrictive recommendations for ESA use; however, the incremental costs and benefits of such a strategy are unknown.


METHODS
The authors created a decision model to examine the costs and consequences of ESA use in patients with anemia and cancer from the perspective of the Canadian public healthcare system. Model inputs were informed by a recent systematic review. Extensive sensitivity analyses and scenario analysis rigorously assessed QOL benefits and more conservative ESA administration practices (initial hemoglobin [Hb] <10 g/dL, target Hb < or =12 g/dL, and chemotherapy induced anemia only).


RESULTS
Compared with supportive transfusions only, conventional ESA treatment was associated with an incremental cost per quality-adjusted life year (QALY) gained of $267,000 during a 15-week time frame. During a 1.3-year time horizon, ESA was associated with higher costs and worse clinical outcomes. In scenarios where multiple assumptions regarding QOL all favored ESA, the lowest incremental cost per QALY gained was $126,000. Analyses simulating the use of ESA in accordance with recently issued guidelines resulted in incremental cost per QALY gained of > $100,000 or ESA being dominated (greater costs with lower benefit) in the majority of the scenarios, although greater variability in the cost-utility ratio was present.


CONCLUSIONS
Use of ESA for anemia related to cancer is associated with incremental cost-effectiveness ratios that are not economically attractive, even when used in a conservative fashion recommended by current guidelines.
Klarenbach
Scott
S
Department of Medicine, University of Alberta Edmonton, Alberta, Canada. swk@ualberta.ca
Manns
Braden
B
Reiman
Tony
T
Reaume
Martin Neil
MN
Lee
Helen
H
Lloyd
Anita
A
Wiebe
Natasha
N
Hemmelgarn
Brenda
B
Tonelli
Marcello
M
D000740:Anemia / Q000150:complications* / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006397:Hematinics / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011788:Quality of Life
D006397:Hematinics