title: Transfusions increase with nationally driven reimbursement changes of erythropoiesis stimulating agents for chemotherapy-induced anemia.
abstract: BACKGROUND
  The Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) in July 2007, which imposed restrictions on the reimbursement of ESAs for Medicare and Medicaid beneficiaries. Since a majority of our patients are Medicare or Medicaid beneficiaries, we changed our clinical practice regarding the use of erythropoiesis stimulating agents (ESAs) to coincide with the NCD's reimbursement restriction.
  
  
  OBJECTIVE
  To evaluate the number of transfusions in patients diagnosed with chemotherapy-induced anemia (CIA) receiving ESAs before and after the clinical practice was changed at the University of Illinois Medical Center (UIMC).
  
  
  METHODS
  The medical records of all adult patients diagnosed with a nonmyeloid malignancy and CIA who received an ESA between July 2006 and June 2008 at the UIMC were evaluated. The patients were divided into two groups: patients in receipt of ESAs BEFORE (group 1) and AFTER (group 2). The number of transfusions, the response rates to chemotherapy and ESAs therapy, and overall survival were compared.
  
  
  RESULTS
  Medical records for 110 patients were reviewed. More transfusions were given to patients AFTER we implemented the change in clinical practice (BEFORE 18 transfusions vs. AFTER 52 transfusions, p = 0.004). More patients responded to ESA therapy AFTER we implemented the change (67% vs. 83%, p = NS). The treatment response to chemotherapy and overall survival were similar between the two groups.
  
  
  CONCLUSIONS
  The primary goal of reducing the number of transfusions in patients with CIA by administering ESAs cannot be met when clinical practice coincides with the NCD.
authors.affiliation: College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612-7230, USA.
authors.forename: Janny Manyan
authors.initials: JM
authors.lastname: Yu
authors.forename: Stacy S
authors.initials: SS
authors.lastname: Shord
authors.forename: Sandra
authors.initials: S
authors.lastname: Cuellar
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced* / Q000191:economics / Q000453:epidemiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics; D001803:Blood Transfusion / Q000191:economics / Q000639:trends*; D005260:Female; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000639:trends; D008297:Male; D008484:Medicaid / Q000191:economics / Q000639:trends*; D006278:Medicare / Q000191:economics / Q000639:trends*; D008875:Middle Aged; D012051:Reimbursement Mechanisms / Q000191:economics / Q000639:trends*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D006397:Hematinics