title: Predicted costs of iron-chelators in myelodysplastic syndromes: a 10-year analysis based on actual prevalence and red cell transfusion rates.
abstract: Consideration of iron-chelation (IC) in transfusion-dependent patients is recommended in most clinical-practice guidelines on myelodysplastic syndromes (MDS). The financial impact of IC on health-care systems is predicted through economic modeling, but an analysis based on actual prevalence is lacking. Here, we have investigated the potential drug-costs and need for IC in a cohort of 189 United Kingdom-based MDS patients diagnosed from 2000 to 2010. Patients with low or intermediate-1 IPSS scores were identified as eligible for IC if ≥24 red cell units (RCU) had been transfused over 12 consecutive months or the transfusion-intensity averaged ≥2 RCU per month. Drug-costs were calculated from the time patients qualified for IC until death or last follow-up. In 159 patients with low/intermediate-1 MDS, survival was superior with a low IPSS score (P = 0.014), age <70 years (P = 0.043), transfusion-independence at diagnosis (P = 0.0056) and transfusion-intensity of <2 RCU per month (P = 0.009). Reflecting the time elapsed since diagnosis, longer survival was observed with a cumulative red cell load of ≥75 U (P = 0.046). By logistic-regression analysis, transfusion-intensity independently predicted survival (P = 0.0035) in low and intermediate-1 risk MDS patients. Forty-one patients fulfilled criteria for consideration of IC. Of these, 6 patients died within 1 month; 35 patients survived for a median of 16 months (range 1-61). Had patients commenced IC, the anticipated drug-costs alone would have been ~$526,880-$2,064,800 over 10 years. The lack of association between cumulative transfusion-load and survival calls for a prospective evaluation of the cost-utility of IC in patients surviving long-term, to enable evidence-based recommendations in MDS management.
authors.affiliation: Department of Hematology, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Durairaj
authors.forename: Stephen
authors.initials: S
authors.lastname: Chew
authors.forename: Ann
authors.initials: A
authors.lastname: Hyslop
authors.forename: Norene
authors.initials: N
authors.lastname: Keenan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Groves
authors.forename: Sudhir
authors.initials: S
authors.lastname: Tauro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D015913:Chelation Therapy / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D006486:Hemosiderosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007502:Iron Chelating Agents / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D007502:Iron Chelating Agents