Hemoglobin Trends and Anemia Treatment Resulting From Concomitant Chemotherapy in Community Oncology Clinics

Section: Discussionsupporting

confidence: 92%

“…Our results are consistent with prior studies showing decreases in ESA use and increases in transfusion use following the ESA label change and subsequent NCD. Henry et al showed that the number of ESA administrations per patient decreased from a mean of 4.6 to 2.9 following the NCD, nearly identical to our results.…”

Section: Discussionmentioning

confidence: 95%

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

Gawade

Berlin

Henry

et al. 2017

“…If, in the post‐NCD period, practice patterns changed such that hemoglobin thresholds at which transfusions are given to chemotherapy‐treated cancer patients decreased, a tendency toward increased transfusions in the post‐NCD period would be blunted. Although lower hemoglobin levels among chemotherapy‐treated cancer patients post‐NCD have been reported, the one published report we are aware of regarding hemoglobin levels at transfusion reports no significant difference pre‐NCD/post‐NCD …”

Section: Discussionmentioning

confidence: 77%

“…Interpreting this study's results is difficult because adjustments were not made for pre‐NCD/post‐NCD differences in the patient populations receiving ESAs. Finally, a second study involving Georgia Cancer Specialists chemotherapy‐treated cancer patients compared ESA and transfusion use in 2006 and 2009 . Calculations from results of this study of patients of all ages and all cancer types indicate that ESA use decreased from 52.0% in 2006 to 13.5% in 2009, and transfusion use increased from 10.0% to 10.7% (relative increase, 7%).…”

Section: Discussionmentioning

confidence: 97%

“…At the time we performed our study, published studies describing the NCD impact on patient care suggested an increase in transfusions among chemotherapy‐treated cancer patients; however, these studies involved single centers or regional groups of clinics. A more recently published study involves oncology centers from around the country, but is not necessarily nationally representative .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Centers for Medicare & Medicaid Services national coverage determination on erythropoiesis‐stimulating agent and transfusion use in chemotherapy‐treated cancer patients

Arneson

Gilbertson

et al. 2012

Trends in Erythropoiesis‐stimulating agent use and blood transfusions for chemotherapy‐induced anemia throughout FDA's risk evaluation and mitigation strategy lifecycle

Vega

Zhang

Wong

et al. 2021

Purpose Erythropoiesis‐stimulating agents (ESAs), indicated for treating some patients with chemotherapy‐induced anemia (CIA), may increase the risk of tumor progression and mortality. FDA required a Risk Evaluation and Mitigation Strategy (REMS) to mitigate these risks. We assessed REMS impact on ESA administration and red blood cell (RBC) transfusion as surrogate metrics for REMS effectiveness. Methods Retrospective cohort study including data from January 1, 2006 to December 31, 2018 for beneficiaries ≥65 years enrolled in Centers for Medicare & Medicaid Services (CMS) Medicare Parts A/B with a cancer diagnosis; patients with other indications for ESA use were excluded. Study time was divided into five periods demarcated by issuance of CMS National Coverage Determination (NCD) (Pre‐NCD, Pre‐REMS) and REMS milestones (Grace Period, REMS, post‐REMS). Study outcomes were monthly proportion of chemotherapy episodes (CTEs) with concomitant ESA administration, with post‐CTE ESA administration, and with RBC transfusions. Results Of 1 778 855 beneficiaries treated with CT, 308742 received concomitant ESA for CIA. The proportion of CTEs with concomitant and post‐CTE ESA administration decreased Pre‐REMS (9.0 percentage points [pp] and 3.5 pp, respectively). There were no significant post‐REMS changes in the proportion of CTEs with concomitant (0.0 pp) and post‐CTE ESA administration (0.1 pp). Fluctuation in RBC transfusions was <4 pp throughout the study period. Conclusions Medicare beneficiaries showed a substantive decrease in ESA administration after NCD, with minimal impact by the REMS and its removal. Small changes in RBC transfusion over the study period were likely due to a national secular trend.