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

Abstract

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.

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

“…Three cost-utility studies [114][115][116] included in the systematic review reported by Wilson and colleagues 2 are also included in the update review and are hence not reported here. …”

“…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.…”

“…Barosi and colleagues 114 The combination of improved quality of life and reduced risk from blood-borne diseases transmitted through RBCTs resulted in a gain of 0.023 QALYs (8.4 quality-adjusted life-days) at an additional cost of US$4362, resulting in an ICER of US$190,000 per QALY.…”

“…Five of the 11 studies were cost-utility analyses: l the HTA review by Wilson and colleagues 2 was carried out for the previous NICE appraisal l the study by Fagnoni and colleagues 121 was also identified in this update review l the studies by Martin and colleagues, 116 Cremieux and colleagues 115 and Barosi and colleagues 114 were all included in the systematic review reported by Wilson and colleagues. 2 Quality appraisal of these studies demonstrated that none met all of the quality criteria but all met most of the quality criteria.…”

Blood Transfusion Requirements for Patients With Sarcomas Undergoing Combined Radio‐ and Chemotherapy

“…In a study in which EPO was actually used for treatment, a higher cost ratio of 3.9 was suggested [41]. In a study of cost-effectiveness of recombinant human EPO (rHuEPO) in the prevention of chemotherapy-induced anaemia, Barosi et al [40] estimated that the cost of rHuEPO was always greater than $100 000 per quality-adjusted life year (QALY). They concluded that according to current use, rHuEPO is not cost-effective in the treatment of chemotherapy-induced anaemia.…”