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Symptom Management and Supportive Care

Health Economic Evaluation of Treating Anemia in Cancer Patients Receiving Chemotherapy: A Study in Belgian Hospitals

^aIMS Health, Brussels, Belgium; ^bGhent University, Ghent, Belgium

Key Words. Anemia • Cancer • Chemotherapy • Economic • Erythropoiesis-stimulating agents • Transfusion

Correspondence: Erik Spaepen, M.Sc., IMS Health, Rue de Crayer 6, 1000, Brussels, Belgium. Telephone: 32-2-627-3211; Fax: 32-2-627-3334; e-mail: ESpaepen{at}be.imshealth.com; Erik219{at}yahoo.com

Received November 7, 2007; accepted for publication March 28, 2008.

Disclosure: L.A. has performed contract work for Ghent University. N.D. has performed contract work for IMS Health. E.S. is an employee of IMS Health and has worked as a contractor for Amgen regarding erythropoietins. The study was performed by IMS for Amgen and funded by an educational grant from Amgen. The authors acknowledge that E.S. and N.D. received payment from Amgen for writing the article.

Background. Erythropoiesis-stimulating agents (ESAs) are used in chemotherapy-induced anemia (CIA) with the goal of improving quality of life and preventing RBC transfusions. This retrospective database study compared the three currently available ESAs, epoetin alfa (EPO-A), epoetin beta (EPO-B), and darbepoetin alfa (DARB), regarding costs and outcomes.

Methods. Data were obtained from a Belgian longitudinal database, including medical and financial data on cancer patients receiving chemotherapy and ESAs, submitted by 46 Belgian hospitals. Propensity score matching was applied to correct for selection bias. The main effectiveness parameter was defined as transfusion- and anemia-readmission-free survival (TA-free survival) at 3 months. Costs were analyzed taking the health care payer perspective.

Results. Including 1,584 EPO-A, 380 EPO-B, and 429 DARB propensity-matched patients, TA-free survival rates were similar for the three groups (DARB, 84.37%; EPO-A, 84.60%; EPO-B, 84.94%). Overall inpatient costs were 16,949 ± 1,025, 19,472 ± 901, and 19,295 ± 1,048 for DARB, EPO-A, and EPO-B, respectively (DARB versus EPO-A, p < .0001 and DARB versus EPO-B, p = .008). Anemia-associated costs were 3,051 ± 218 in the DARB group, compared with 3,995 ± 144 for EPO-A (p < .0001) and 3,752 ± 229 for EPO-B (p = .0132).

Conclusion. To our knowledge, this is the first real-life matched retrospective study comparing ESAs with regard to both costs and effects. For similar patient profiles, the patients in the DARB group consumed the smallest amounts of ESAs, with similar clinical outcomes. These data therefore suggest a greater efficiency of DARB in the treatment of CIA.