Cost Comparison of Recombinant Human Erythropoietin and Blood Transfusion in Cancer Chemotherapy-Induced Anemia

Sheffield, Reinée E; Sullivan, Sean D.; Saltiel, Emmanuel; Nishimura, Lyn

doi:10.1177/106002809703100101

Cited by 51 publications

(33 citation statements)

References 47 publications

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“…In a cost comparison of rHuEPO vs leucocyte-depleted RBC transfusion therapy, with a response rate of 64% with rHuEPO, full cost of the drug and 8 months of therapy, RBC transfusion resulted in a saving of $8490 per patient (Sheffield et al, 1997). In a cost-effectiveness analysis that considered a longer duration for therapy and efficacy data from clinical trials (Barosi and Liberato, 1995), the baseline cost-effectiveness ratio was more than $100 000 per QALY.…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia

Barosi

Marchetti²,

Liberato³

1998

Br J Cancer

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Summary Recombinant human erythropoietin (rHuEPO) has been advocated for the treatment of anaemia in patients submitted to cancer chemotherapy. We used decision analysis to compare the cost-effectiveness of rHuEPO supplemented with red blood cell (RBC) transfusions with conventional treatment with RBC transfusions alone. At Anaemia is a frequent complication in patients with cancer receiving cytotoxic chemotherapy. It impairs patients' physical capabilities and subjective sense of well-being, diminishing their quality of life. In controlled randomized studies, rHuEPO was associated with increased haemoglobin level, decreased transfusion requirements and improved quality of life (Abels, 1993;Case et al, 1993; Finelli et al, 1993;Cascinu et al, 1994;Henry and Abels, 1994;Cazzola et al, 1995;De Campos et al, 1995;Garton et al, 1995; Oesterborg et al, 1996;ten Bokkel-Huinink, 1996; Wurnig et al, 1996;Del Mastro et al, 1997). As the same results were obtained in a community oncology practice setting (Glaspy et al, 1997), recommendations for rHuEPO use and a treatment algorithm for its optimization were outlined (Glaspy et al, 1997).In contrast, because of increasing financial constraints throughout health care systems, the amount of money allotted for a new treatment has to be considered in relation to the magnitude of the benefit offered with respect to traditional therapy. As a consequence, cost-effectiveness analysis belongs to the development process aimed at establishing policy for drug use. The purpose of this work is to provide a cost-effectiveness analysis of rHuEPO in the chemotherapy-induced anaemia of cancer.Received 26 September 1997 Revised 30 January 1998 Accepted 16 March 1998 Correspondence to: G Barosi, Laboratorio di Informatica Medica, IRCCS Policlinico S. Matteo, Piazzale Golgi 2, 27100 Pavia, Italy METHODS Base caseAs the best strategy for administering rHuEPO to patients undergoing cancer chemotherapy has not yet been determined, at baseline we modelled the most resource-saving treatment strategy, i.e. the use of the drug for secondary prophylaxis, reserved for patients who had developed severe anaemia as a consequence of chemotherapy. The case upon which this analysis is based was derived from the results of a community-based US multicentre oncology study (Glaspy et al, 1997). As such, a hypothetical typical patient fulfilling the criteria for therapy receives treatment at a mean age of 65 years, does not carry any other cause for anaemia except cancer chemotherapy, always has an expected survival of more than 6 months and is treated with rHuEPO when haemoglobin falls below 10.7 g dl-'. To better reflect the health care system perspective, we assumed that both rHuEPO and RBC transfusions were administered in the hospital. We outlined our model on the basis of a 4-month course of rHuEPO with doses of 150 units kg-' three times per week, i.e. according to the protocol providing treatment guidance for patients in the community setting.

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Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia

Barosi

Marchetti²,

Liberato³

1998

Br J Cancer

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“…Studies examining the cost-effectiveness of epoetin used in the cancer setting have produced mixed conclusions, but these findings are based on clinical trial results from the early-tomid 1990s (Cremieux et al, 1999;Sheffield et al, 1997). Findings from more recently published clinical studies, including this one, suggest a need to examine the cost-effectiveness of epoetin b taking into consideration (1) the value of targeting patients using serologic markers at baseline and early in treatment, (2) the public concern about the safety of the blood supply and (3) the prospect that better anaemia management may improve survival.…”

Section: P<0001mentioning

confidence: 99%

Impact of epoetin β on quality of life in patients with malignant disease

Boogaerts¹,

Coiffier

Kainz³

2003

Br J Cancer

117

114

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This open-label, prospective study was conducted to compare the impact of epoetin b vs standard care on quality of life (QoL) in anaemic patients with lymphoid or solid tumour malignancies. A total of 262 anaemic patients (haemoglobin [Hb]p11 g dl À1 ) were randomised to a 12-week treatment with s.c. epoetin b (initial dose 150 IU kg À1 three times weekly) or standard care. Transfusions were recommended for both groups at an Hb threshold of 8.5 g dl À1 . The primary efficacy variables were improvement in QoL as measured using the Short-Form-36 physical component summary (SF-36 PCS) score and the Functional Assessment of Cancer Therapy fatigue and anaemia subscales (FACT-F and FACT-An). A visual analogue scale (VAS) was also used as a global QoL measure. Clinical response was defined as a X2 g dl À1 increase in Hb level without need of transfusion after the initial 4 weeks of treatment. Baseline to final visit changes in SF-36 PCS, FACT-F and VAS scores were significantly greater with epoetin b than with standard care (Po0.05); changes in FACT-An subscale score tended to be greater with epoetin b (P ¼ 0.076). Epoetin b significantly increased Hb concentrations relative to standard care (responders: 47% vs 13%; Po0.001). Levels of endogenous erythropoietin o50 mIU ml À1 were significantly predictive of response (OR 2.496, 95% CI: 1.21 -5.13). Epoetin b therapy significantly improves QoL compared with standard care in anaemic patients with solid tumours and lymphoid malignancies.

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“…Full texts were retrieved for 44 citations (the remainder being excluded as irrelevant on the basis of title and/or abstract). Five studies [114][115][116][117][118] were included following full-text screening (the remainder generally being excluded for not considering both costs and benefits). Figure 24 provides the study flow diagram for the systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…The incremental costs outweighed the benefits in monetary terms and the conclusion was therefore that epoetin alfa was less cost-effective than standard care with RBCT. Sheffield and colleagues 118 used a decision tree to model the costs and consequences of epoetin alfa use and concluded that epoetin alfa would be dominated by standard care with RBCT; that is, it would be more expensive and produce worse outcomes. Wilson and colleagues 2 highlighted several assumptions made that seemed implausible.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

The effectiveness and cost-effectiveness of erythropoiesis-stimulating agents (epoetin and darbepoetin) for treating cancer treatment-induced anaemia (including review of technology appraisal no. 142): a systematic review and economic model

Crathorne

Huxley

Haasova

et al. 2016

Health Technol Assess

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BackgroundAnaemia is a common side effect of cancer treatments and can lead to a reduction in quality of life. Erythropoiesis-stimulating agents (ESAs) are licensed for use in conjunction with red blood cell transfusions to improve cancer treatment-induced anaemia (CIA).ObjectiveTo investigate the effectiveness and cost-effectiveness of ESAs in anaemia associated with cancer treatment (specifically chemotherapy).Data sourcesThe following databases were searched from 2004 to 2013: The Cochrane Library, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, Health Management Information Consortium, Current Controlled Trials and ClinicalTrials.gov. The US Food and Drug Administration and European Medicines Agency websites were also searched. Bibliographies of included papers were scrutinised for further potentially includable studies.Review methodsThe clinical effectiveness review followed principles published by the NHS Centre for Reviews and Dissemination. Randomised controlled trials (RCTs), or systematic reviews of RCTs, of ESAs (epoetin or darbepoetin) for treating people with CIA were eligible for inclusion in the review. Comparators were best supportive care, placebo or other ESAs. Anaemia- and malignancy-related outcomes, health-related quality of life (HRQoL) and adverse events (AEs) were evaluated. When appropriate, data were pooled using meta-analysis. An empirical health economic model was developed comparing ESA treatment with no ESA treatment. The model comprised two components: one evaluating short-term costs and quality-adjusted life-years (QALYs) (while patients are anaemic) and one evaluating long-term QALYs. Costs and benefits were discounted at 3.5% per annum. Probabilistic and univariate deterministic sensitivity analyses were performed.ResultsOf 1457 titles and abstracts screened, 23 studies assessing ESAs within their licensed indication (based on start dose administered) were included in the review. None of the RCTs were completely aligned with current European Union licenses. The results suggest a clinical benefit from ESAs for anaemia-related outcomes and an improvement in HRQoL scores. The impact of ESAs on AEs and survival remains highly uncertain, although point estimates are lower, confidence intervals are wide and not statistically significant. Base-case incremental cost-effectiveness ratios (ICERs) for ESA treatment compared with no ESA treatment ranged from £19,429 to £35,018 per QALY gained, but sensitivity and scenario analyses demonstrate considerable uncertainty in these ICERs, including the possibility of overall health disbenefit. All ICERs were sensitive to survival and cost.LimitationsThe relative effectiveness of ESAs was not addressed; all ESAs were assumed to have equivalent efficacy. No studies were completely aligned with their European labelling beyond the starting dose evaluated. There is questionable generalisability given that the included trials were published > 20 years ago and there have been many changes to chemotherapy as well as to the quality of supportive treatment. Trial quality was moderate or poor and there was considerable unexplained heterogeneity for a number of outcomes, particularly survival, and evidence of publication bias. Adjustments were not made to account for multiple testing.ConclusionsESAs could be cost-effective when used closer to licence, but there is considerable uncertainty, mainly because of unknown impacts on overall survival.Study registrationThis study is registered as PROSPERO CRD42013005812.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost Comparison of Recombinant Human Erythropoietin and Blood Transfusion in Cancer Chemotherapy-Induced Anemia

Cited by 51 publications

References 47 publications

Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia

Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia

Impact of epoetin β on quality of life in patients with malignant disease

The effectiveness and cost-effectiveness of erythropoiesis-stimulating agents (epoetin and darbepoetin) for treating cancer treatment-induced anaemia (including review of technology appraisal no. 142): a systematic review and economic model

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