, Volume 16, Issue 5, pp 459–472

Cost Effectiveness, Quality-Adjusted Life-Years and Supportive Care

Recombinant Human Erythropoietin as a Treatment of Cancer-Associated Anaemia


    • Analysis Group/Economics
    • Department of EconomicsUniversity of Quebec
  • Stan N. Finkelstein
    • Sloan School of ManagementMassachusetts Institute of Technology
  • Ernst R. Berndt
    • Sloan School of ManagementMassachusetts Institute of Technology
  • Jeffrey Crawford
    • Duke University Medical Center
  • Mitchell B. Slavin
    • Clinical Affairs, Ortho Biotech Inc.
Original Research Article

DOI: 10.2165/00019053-199916050-00004

Cite this article as:
Cremieux, P., Finkelstein, S.N., Berndt, E.R. et al. Pharmacoeconomics (1999) 16: 459. doi:10.2165/00019053-199916050-00004


Objective: To measure the cost effectiveness of a supportive care intervention when the no-treatment option is unrealistic in an analysis of recombinant human erythropoietin (epoetin) treatment for anaemic patients with cancer undergoing chemotherapy. Further, to assess whether quality-adjusted life-years (QALYs) can provide the basis for an appropriate measure of the value of supportive care interventions.

Design: A modelling study drawing cost and effectiveness assumptions from a literature review and from 3 US clinical trials involving more than 4500 patients with cancerwhowere treatedwith chemotherapy, radiotherapy, epoetin and blood transfusions as needed under standard care for patients with cancer.

Main outcome measures and results: When compared with transfusions, epoetin is cost effective under varying assumptions, whether effectiveness is measured by haemoglobin level or quality of life. Specifically, under a base-case scenario, the effectiveness resulting from $US1 spent on standard care can be achieved with only $US0.81 of epoetin care. Due in part to the health-state dependence of the significance patients attach to incremental changes in their responses on the linear analogue scale, cost per QALY results are ambiguous in this supportive care context.

Conclusions: Under a broad range of plausible assumptions, epoetin can be used cost effectively in the treatment of anaemic patients with cancer. Further, QALYs have limited applicability here because, as a short term supportive treatment, epoetin enhances the quality but not the length of life. Future research would benefit from the establishment of consistent values for quality-of-life changes across patients and health status, and the extension of the QALY framework to supportive care.

Copyright information

© Adis International Limited 1999