Original Research Article


, Volume 16, Issue 5, pp 459-472

First online:

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

Recombinant Human Erythropoietin as a Treatment of Cancer-Associated Anaemia
  • Pierre-Yves CremieuxAffiliated withAnalysis Group/EconomicsDepartment of Economics, University of Quebec Email author 
  • , Stan N. FinkelsteinAffiliated withSloan School of Management, Massachusetts Institute of Technology
  • , Ernst R. BerndtAffiliated withSloan School of Management, Massachusetts Institute of Technology
  • , Jeffrey CrawfordAffiliated withDuke University Medical Center
  • , Mitchell B. SlavinAffiliated withClinical Affairs, Ortho Biotech Inc.

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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.