title: Patterns of erythropoiesis-stimulating agent use among Medicare beneficiaries with myelodysplastic syndromes and consistency with clinical guidelines.
abstract: Erythropoiesis-stimulating agents (ESA) are used commonly to reduce symptomatic anemia in patients with myelodysplastic syndromes (MDS). We assessed population-based patterns of ESA use relative to treatment guidelines using data from the Surveillance, Epidemiology, and End Results (SEER) registries, with linked Medicare claims providing detailed treatment data from 2001 through 2005. The study found widespread use (62%) of ESA in Medicare beneficiaries with MDS. Similar ESA use rates regardless of risk status, low frequency (45%) of serum erythropoietin determination prior to ESA initiation, and high prevalence (60.4%) of short-duration ESA episodes suggest clinically important discrepancies between actual practice and guideline-recommended therapy.
authors.affiliation: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. amy.davidoff@ahrq.hhs.gov
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Weiss
authors.forename: Maria R
authors.initials: MR
authors.lastname: Baer
authors.forename: Xuehua
authors.initials: X
authors.lastname: Ke
authors.forename: Franklin
authors.initials: F
authors.lastname: Hendrick
authors.forename: Amer
authors.initials: A
authors.lastname: Zeidan
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000068256:Darbepoetin alfa; D004363:Drug Utilization; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012042:Registries / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
chemical_list: D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa