Skip to main content
SpringerLink
Log in

Analisi dei costi degli agenti stimolanti l’eritropoiesi nel trattamento dell’anemia indotta da chemioterapia: l’esperienza della ASL della provincia di Alessandria

Cost minimization analysis of erythropoietin receptor agonists in the treatment of cancer patients with anemia: the experience of the Local Health Unit of Alessandria

  • Published:
PharmacoEconomics Italian Research Articles

Abstract

Introduction

Considering the Italian setting, only limited information is available on the economic impact of erythropoiesis stimulating agents (ESAs) [epoetin-α, epoetin-β and darbepoetin-α] in the treatment of anaemia in cancer patients on chemotherapy.

Materials and methods

Data for this retrospective study were derived from the administrative database of the middle-size (450,000 subjects/year) Local Health Unit of Alessandria. A sample was built by selecting all patients who, between 2007 and 2008, had a cancer diagnosis and received at least one prescription for ESAs. The study evaluated durations and costs per event (anemia) associated with either treatments.

Results

The sample consisted of 221 patients (mean age: 66.4 years, 50.2% females). The mean duration of treatment was 9.0 weeks for epoetin-α and 10.9 weeks for darbepoetin-α (p = 0.164). The mean cost was €2,350.49/event treated with epoetin-α and €2,687.64/event treated with darbepoetin-α (p = 0.41).

Discussion and conclusions

Based on data from an Italian Local Health Unit, we performed an analysis focused on the use of ESAs in the treatment of anemia in cancer patients on chemotherapy. Analysis results were interesting, particularly as an attempt to estimate the mean cost of treatment per event of epoetin-α and darbepoetin-α; this result was consistent with a previous Italian study, where epoetin-α showed to be cost-saving compared with darbepoetin-α in the treatment of chemotherapy related anemia, though the difference of treatment cost was not significant (p = 0.41).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Bibliografia

  1. Schwartzberg LS, Yee LK, Senecal FM, et al. A randomized comparison of every-2-week darbepoetin α and weekly epoetin α for the treatment of chemotherapy-induced anemia in patients with breast, lung, or gynecologic cancer. Oncologist 2004; 9: 696–707

    Article  PubMed  CAS  Google Scholar 

  2. Reichardt B. Cost comparison of epoetin alpha, epoetin beta and darbepoetin alpha for cancer patients with anaemia in the clinical practice setting. J Clin Pharm Ther 2006; 31: 503–12

    Article  PubMed  CAS  Google Scholar 

  3. Coiffier B, Guastalla JP, Pujade-Lauraine E, et al. Predicting cancer-associated anaemia in patients receiving non-platinum chemotherapy: results of a retrospective survey. Eur J Cancer 2001; 37: 1617–23

    Article  PubMed  CAS  Google Scholar 

  4. Denison U, Baumann J, Peters-Engl C, et al. Incidence of anaemia in breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat 2003; 79: 347–53

    Article  PubMed  CAS  Google Scholar 

  5. Steurer M, Wagner H, Gastl G. Prevalence and management of anemia in haematologic cancer patients receiving cyclic nonplatinum chemotherapy: results of a prospective national chart survey. Wien Klin Wochenschr 2004; 116: 367–72

    Article  PubMed  Google Scholar 

  6. Ludwig H, Van Belle S, Barrett-Lee PJ, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence and treatment of anaemia in cancer patients. Eur J Cancer 2004; 40: 2293–306

    Article  PubMed  Google Scholar 

  7. Cella D, Dobrez D, Glaspy JA. Control of cancer-related anemia with erythropoietic agents: a review of evidence for improved quality of life and clinical outcomes. Ann Oncol 2003; 14: 511–9

    Article  PubMed  CAS  Google Scholar 

  8. Barnett A, Crémieux PY, Fendrick MA, et al. Anemia related costs for cancer patients. J Manag Care Med 2002; 6: 20–8

    Google Scholar 

  9. Cremieux PC, Vekeman F, Lefebvre P. Dose conversion and cost effectiveness of erythropoietic therapies in chemotherapy-related anemia: a Canadian application. J Oncol Pharm Practice 2006; 12: 165–78

    Article  CAS  Google Scholar 

  10. Duh MS, Lefebvre P, Fastenau J. Assessing the clinical benefits of erythropoietic agents using area under the hemoglobin change curve. Oncologist 2005; 10: 438–48

    Article  PubMed  CAS  Google Scholar 

  11. Fallowfield L, Gagnon D, Zagari M, et al. Multivariate regression analyses of data from a randomised, double-blind, placebo-controlled study confirm quality of life benefit of epoetin a in patients receiving non-platinum chemotherapy. Br J Cancer 2002; 87: 1341–53

    Article  PubMed  CAS  Google Scholar 

  12. Leitgeb C, Pecherstorfer M, Fritz E, et al. Quality of life in chronic anemia of cancer during treatment with recombinant human erythropoietin. Cancer 1994; 73: 2535–42

    Article  PubMed  CAS  Google Scholar 

  13. Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 1997; 34: 4–12

    PubMed  CAS  Google Scholar 

  14. Cella D. Factors influencing quality of life in cancer patients: anemia and fatigue. Semin Oncol 1998; 25: 43–6

    PubMed  CAS  Google Scholar 

  15. http://www.aiom.it/Attivit%E0+Scientifica/Linee+guida/Gestione+della+tossicit%E0+ematopoietica+in+Oncologia/1,83,0,Dataultimoaccessomaggio 2010

  16. Bohlius J, Wilson J, Seidenfeld J, et al. Recombinant human erythropoietin and cancer patients: updated meta-analysis of 57 studies including 9353 patients. J Natl Cancer Inst 2006; 98: 708–14

    Article  PubMed  CAS  Google Scholar 

  17. Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA 2008; 299: 914–24

    Article  PubMed  CAS  Google Scholar 

  18. Bohlius J, Schmidin K, Schwarzer G, et al. Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomized trials. Lancet 2009; 373: 1532–42

    Article  PubMed  CAS  Google Scholar 

  19. Hadland B, Longmore GD. Erythroid-stimulating agents in cancer therapy: potential dangers and biologic mechanisms. J Clin Oncol 2009; 25: 4217–26

    Article  Google Scholar 

  20. Epoetin A (EPREX®). Product package insert. Retrieved 23 August 2005, from http://www.janssen-ortho.com/JOI/pdf_ files/Eprex_E.pdf

  21. Epoetin A (PROCRIT®). Product package insert. Retrieved 23 August 2005, from http://www.procrit.com/common/prescribing_information/PROCRIT/PDF/ProcritBooklet.pdf

  22. Darbepoetin A (Aranesp®). Product package insert. Retrieved 23 August 2005, from http://www.aranesp.com/pdf/aranesp_PI.pdf

  23. Demetri GD, Kris M, Wade J, et al. Quality-of-life benefit in chemotherapy patients treated with epoetin α is independent of disease response or tumor type: results from a prospective community oncology study. Procrit study group. J Clin Oncol 1998; 16: 3412–25

    PubMed  CAS  Google Scholar 

  24. Gabrilove JL, Cleeland CS, Livingston RB, et al. Clinical evaluation of once-weekly dosing of epoetin α in chemotherapy patients: improvements in haemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol 2001; 19: 2875–82

    PubMed  CAS  Google Scholar 

  25. Vansteenkiste J, Pirker R, Massuti B, et al. Double-blind, placebo-controlled, randomized phase III trial of darbepoetin alfa in lung cancer patients receiving chemotherapy. J Natl Cancer Inst 2002; 94: 1211–20

    Article  PubMed  CAS  Google Scholar 

  26. Vadhan-Raj S, Mirtsching B, Charu V, et al. Assessment of hematologic effects and fatigue in cancer patients with chemotherapy-induced anemia given darbepoetin α every two weeks. J Support Oncol 2003; 1: 131–8

    PubMed  CAS  Google Scholar 

  27. Witzig TE, Silberstein PT, Loprinzi CL, et al. Phase III, randomized, double-blind study of epoetin α versus placebo in anemic patients with cancer undergoing chemotherapy. J Clin Oncol 2004; 22: 1–12

    Google Scholar 

  28. Chang J, Couture F, Young S, et al. Once weekly epoetin α maintains hemoglobin, improves quality of life, and reduces transfusion in breast cancer patients receiving chemotherapy. J Clin Oncol 2004; 23: 2597–605

    Article  PubMed  Google Scholar 

  29. Glaspy J, Henry D, Patel R, et al. Effects of chemotherapy on endogenous erythropoietin levels and the pharmacokinetics and erythropoietic response of darbepoetin α: a randomised clinical trial of synchronous versus asynchronous dosing of darbepoetin α. Eur J Cancer 2005; 41: 1140–9

    Article  PubMed  CAS  Google Scholar 

  30. Crawford J, Cella D, Cleeland CS, et al. Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin α therapy. Cancer 2002; 95: 888–95

    Article  PubMed  CAS  Google Scholar 

  31. Littlewood T, Bajetta E, Rapoport B, et al. Early administration of epoetin α optimizes anemia management with respect to hematologic and quality of life (QOL) outcomes in anemic cancer patients (pts) undergoing chemotherapy. Blood 2002; 100: 18b [abstract]

    Google Scholar 

  32. Shasha D, George M. Rapid haemoglobin response in anemic cancer patients undergoing chemotherapy or chemoradiation therapy receiving once-weekly epoetin α treatment. Blood 2002; 100: 17b [abstract]

    Article  Google Scholar 

  33. Ravasio R, Bernardo G, Cerra C, et al. Analisi di minimizzazione dei costi degli agenti stimolanti l’eritropoiesi nel trattamento dell’anemia indotta da chemioterapia. PharmacoEconomics-Italian Research Articles 2009; 11: 15–23

    Google Scholar 

  34. Ben-Hamadi R, Duh MS, Aggarwal J. The cost-effectiveness of weekly epoetin α relative to weekly darbepoetin α in patients with chemotherapy-induced anemia. Curr Med Res Opin 2005; 21: 1677–82

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Wolters Kluwer Health Italy Ltd, Milano, Italia

    R. Ravasio

  2. Dipartimento del Farmaco, Azienda Sanitaria Locale di Alessandria, Italia

    M. D’Orsi, G. F. Zuccotti, A. Girlanda & D. Cantù

  3. SOC Controllo di gestione, Azienda Sanitaria Locale di Alessandria, Italia

    C. Buffa & M. De Petris

Authors
  1. R. Ravasio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. D’Orsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. F. Zuccotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Girlanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Cantù
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Buffa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. De Petris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Ravasio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ravasio, R., D’Orsi, M., Zuccotti, G.F. et al. Analisi dei costi degli agenti stimolanti l’eritropoiesi nel trattamento dell’anemia indotta da chemioterapia: l’esperienza della ASL della provincia di Alessandria. Pharmacoeconomics-Ital-Res-Articles 12, 175–182 (2010). https://doi.org/10.1007/BF03320675

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03320675

Search

Navigation