Economic analysis of epoetin alfa in critically ill trauma patients.
BACKGROUND
Recent randomized control trials (RCTs) suggest that epoetin alfa reduces mortality in critically ill trauma patients; however, epoetin alfa is also costly and associated with adverse events. This study evaluates the cost-effectiveness of epoetin alfa in surgical trauma patients in an intensive care unit setting.


METHODS
We constructed a decision analytic model to compare adjunctive use of epoetin alfa with standard care in trauma patients from the perspective of a Canadian payer. Baseline risks of events, relative efficacy, and resource use were obtained from RCTs and observational studies. One-way and probabilistic sensitivity analyses were conducted and longer time horizons explored through Markov models.


RESULTS
Epoetin alfa was associated with a cost per quality-adjusted life year (QALY) gained of $89,958 compared with standard care at 1 year. One-way sensitivity analyses indicated that results were sensitive to plausible ranges of mortality risk, risk of thrombosis, relative risk of mortality, relative risk of thrombosis, and quality of life estimates. Cost-effectiveness acceptability curves generated from probabilistic sensitivity analysis indicated that the probability that epoetin alfa would be considered attractive ranged from 0% to 85% over a willingness-to-pay range of $25,000 to $120,000/QALY. Consideration of lifetime time horizons reduced the cost per QALY gained to $7,203, but results were sensitive to the effect of epoetin alfa on mortality.


CONCLUSIONS
Although the cost per QALY gained with epoetin alfa use may fall into an acceptable range, there is significant uncertainty about its true cost-effectiveness. If data regarding long-term efficacy and safety are confirmed in future trials, epoetin alfa could potentially be cost-effective in this population.


METHODS
Economic analysis, level I.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. betty.chui@ualberta.ca
Betty K
BK
Chui
Neesh
N
Pannu
Maureen
M
Hazel
James
J
Dong
Marcello
M
Tonelli
Scott W
SW
Klarenbach
D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods; D016638:Critical Illness / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D017059:Models, Econometric; D009010:Monte Carlo Method; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012306:Risk
D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa