title: Hematologic outcomes and blood utilization in cancer patients with chemotherapy-induced anemia (CIA) pre- and post-national coverage determination (NCD): results from a multicenter chart review.
abstract: OBJECTIVE
  In July 2007, the Centers for Medicare and Medicaid Services (CMS) limited coverage of erythropoiesis-stimulating agents (ESAs) in cancer patients with chemotherapy-induced anemia (CIA) through a National Coverage Determination (NCD). The primary objective of this study was to compare transfusion rates in patients with CIA with lung, breast, or colorectal cancer before and after the NCD.
  
  
  METHODS
  Adult Medicare patients with CIA treated at 49 community oncology clinics were selected from two time periods based on clinics' NCD implementation date. Chart data were abstracted for 12 weeks post-CIA episode start, defined as hemoglobin (Hb) level <11 g/dL while receiving chemotherapy or within 60 days of the last chemotherapy dose. Multivariate analyses were used to calculate the odds of transfusion and to assess the units of blood transfused, controlling for differences in demographics, clinical history, and chemotherapy.
  
  
  RESULTS
  Eight hundred pre-NCD and 994 post-NCD patients from 49 sites were selected. Of the patients, 56% used ESAs post-NCD vs. 88% pre-NCD (p < 0.0001). The duration of ESA use decreased in the post-NCD (32.1 days) vs. pre-NCD (48.4 days, p < 0.0001) group. The post-NCD group reported significantly lower Hb levels, higher odds of receiving a transfusion (odds ratio: 1.41, 95% CI 1.05-1.89, p = 0.0238) and increased blood utilization of 53% (units transfused: OR 1.53, 95% CI 1.15-2.04, p = 0.0034).
  
  
  CONCLUSIONS
  Decreased frequency and duration of ESA administration were reported in the post-NCD vs. pre-NCD period. Findings were accompanied by a modest but statistically significant increase in transfusions and a decrease in Hb values.
authors.affiliation: Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, PA 19106, USA. dhhenry@juno.com
authors.forename: David H
authors.initials: DH
authors.lastname: Henry
authors.forename: Corey J
authors.initials: CJ
authors.lastname: Langer
authors.forename: R Scott
authors.initials: RS
authors.lastname: McKenzie
authors.forename: Catherine Tak
authors.initials: CT
authors.lastname: Piech
authors.forename: Mekré
authors.initials: M
authors.lastname: Senbetta
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Schulman
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Stepanski
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy; D014487:Centers for Medicare and Medicaid Services, U.S.; D015179:Colorectal Neoplasms / Q000097:blood / Q000188:drug therapy; D004920:Erythropoiesis / Q000187:drug effects; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019458:Insurance Coverage; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D014481:United States
chemical_list: D006454:Hemoglobins