Epoetin alfa and darbepoetin alfa for the treatment of chemotherapy-related anemia in cancer patients in Sweden: Comparative analysis of drug utilization, costs, and hematologic response

2005 ◽  
Vol 22 (3) ◽  
pp. 208-224 ◽  
Author(s):  
Ulf Persson ◽  
Sixten Borg ◽  
Sandra Jansson ◽  
Tor Ekman ◽  
Lars Franksson ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Cancer Patients ◽  
Drug Utilization ◽  
Darbepoetin Alfa ◽  
Epoetin Alfa ◽  
Hematologic Response

Use and Outcomes of Epoetin Alfa and Darbepoetin Alfa for Anemic Cancer Patients in Outpatient Community Practice Settings.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5588-5588 ◽  
Author(s):  
Kyle R. Fahrbach ◽  
Diana Frame ◽  
Brian Sercus ◽  
Brad Schenkel
Keyword(s):  
Cancer Patients ◽  
Darbepoetin Alfa ◽  
Selection Criteria ◽  
Tumor Type ◽  
Community Practice ◽  
Epoetin Alfa ◽  
Treatment Episode ◽  
End Of Treatment ◽  
Dosing Regimens ◽  
The Cost

Abstract Objective: To assess the treatment patterns and hematologic outcomes associated with epoetin alfa (EPO) and darbepoetin alfa (DARB) for the treatment of anemic cancer patients in the community practice setting. Methods: A retrospective observational study design was used. De-identified data from patients receiving care in community oncology practice settings were obtained from an electronic medical record system. Eligible patients were >= 18 years of age, had a cancer diagnosis, and were treated with an erythropoiesis stimulating agent (ESA: EPO or DARB) during the period July 2002 – July 2004, with baseline anemia (Hb<=11 g/dL) and at least one follow-up Hb value. No other selection criteria were applied (e.g. ESA dose, tumor type, chemotherapy treatment) in keeping with the objective of characterizing outcomes in a real-world setting. Data were summarized by treatment overall and by using a multivariate model adjusting for age, gender, baseline Hb, clinic site, ECOG performance score, type of cancer (solid vs hematologic) and chemotherapy (platinum vs non-platinum vs. none). Patient selection criteria and analytic methods were determined prospectively. The cost for each ESA was calculated based on 2004 average wholesale prices ($13.36 per EPO 1,000 U; $4.99 per 1 mcg DARB). Results: 2382 EPO and 1399 DARB patients were eligible for analysis. The two groups were comparable in terms of baseline characteristics (62% female, 75% solid tumors, mean baseline Hb 9.9 g/dL). Only about two-thirds of patients were treated with standard dosing regimens of the two agents in the US (EPO 40,000 U qw, DARB 200 mcg q2w). Hematologic outcomes observed in patients receiving EPO were consistently better than those in patients receiving DARB. Table 1. Hematologic outcomes by ESA treatment EPO DARB p value Week 4 Hb change (g/dL) 0.79 0.59 <0.001 % Early Hb response (Hb change >=1 g/dL at 4 weeks) 61.5 55.2 0.004 % Hb response (Hb change >=2 g/dL by end of treatment episode) 41.4 34.7 <0.001 % Hematopoietic response (Hb change >= 2 g/dL or reaching 12 g/dL by end of treatment episode) 52.3 44.6 <0.001 The mean treatment durations for patients receiving EPO and DARB were 55.3 and 62.5 days, respectively. Mean cumulative doses were 231,211 U for EPO and 857 mcg for DARB. These doses resulted in an average cost per patient of $3,089 for those receiving EPO and $4,276 for those receiving DARB. Conclusion: These results, based on over 3000 community-treated cancer patients, reinforce previous findings of earlier and greater overall hematologic response for EPO vs. DARB in this setting. Additionally, based on mean cumulative doses, the cost of DARB per patient was substantially greater than that of EPO. Additional studies of variations in dosing regimens used in the community setting are warranted, as are well-powered, randomized, controlled trials to further confirm the clinical results observed here.

scholarly journals Budget Impact Analysis of Darbepoetin Alfa Every 3 Weeks versus Epoetin Alfa Every Week for Cancer Patients with Anemia due to the Effect of Concomitant Myelosuppressive Chemotherapy

10.36469/9836 ◽  
2015 ◽  
Vol 3 (2) ◽  
pp. 214-223 ◽  
Author(s):  
November McGarvey ◽  
Hairong Xu
Keyword(s):  
Cancer Patients ◽  
Health Plan ◽  
Patient Population ◽  
Darbepoetin Alfa ◽  
Impact Analysis ◽  
Budget Impact ◽  
Drug Costs ◽  
Epoetin Alfa ◽  
Annual Average ◽  
Myelosuppressive Chemotherapy

Background: Anemia is a common complication among patients with cancer receiving chemotherapy and can cause significant costs to health plans. Objective: The objective of this study is to estimate the annual budget impact of drug treatment associated with treating cancer patients with anemia due to the effect of concomitant myelosuppressive chemotherapy (i.e., chemotherapy-induced anemia [CIA]) with erythropoiesis stimulating agents (ESAs), either darbepoetin alfa (DA) once every 3 weeks (Q3W) or epoetin alfa (EA) once every week (QW), for a large US health plan in 2014. Methods: Using a patient database from a large US health plan in 2010 (n = 14 811 119), the potential CIA patient population was determined (1842 patients each per DA and EA). A budget impact of ESA treatment on this patient population in 2014 was calculated. The analysis assumed a minimum of 2 additional months of chemotherapy from initiation of the analysis. The 2014 Centers for Medicare and Medicaid Services (CMS) reimbursement rates used were: average sales price +12% of $3.68/mcg (DA) and $11.38/1000 IU (EA), and office-based injection cost of $25.08. Results: The estimated 2014 annual average drug costs per patient with CIA were $5520 (DA) and $5833 (EA). Annual average drug costs for administrations were estimated at $100 (DA) and $301 (EA) for 2014. Per member per year (PMPY) costs for patients with CIA were estimated at $5620 (DA) and $6134 (EA) for 2014. The annual total costs per CIA population (n=1842) were estimated at $10 352 629 (DA) and $11 298 798 (EA) for 2014. Conclusion: DA Q3W has the potential to provide cost savings over EA QW in terms of annual average drug cost per patient with CIA ($313 savings), PMPY costs for patients with CIA ($514 savings), and total cost per CIA population ($946 169 savings).

Comparison of red blood cell transfusion rates of epoetin alfa and darbepoetin alfa in an inpatient oncology setting

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16002-16002
Author(s):  
F. Vekeman ◽  
R. S. McKenzie ◽  
S. Watson ◽  
S. Mody ◽  
P. Lefebvre ◽  
...  
Keyword(s):  
Blood Cell ◽  
Cancer Patients ◽  
Red Blood Cell ◽  
Darbepoetin Alfa ◽  
Relative Effectiveness ◽  
Red Blood Cell Transfusion ◽  
Inpatient Setting ◽  
Epoetin Alfa ◽  
Transfusion Requirements ◽  
Rbc Transfusion

16002 Background: Epoetin alfa (EPO) and darbepoetin alfa (DARB) are used to treat cancer-related anemia and to reduce the requirements for blood transfusions. To date, limited information on the relative effectiveness of these agents in the inpatient setting is available. This analysis evaluated red blood cell (RBC) transfusion rates in cancer patients receiving EPO or DARB during hospitalization. Methods: An analysis of electronic inpatient hospital records from the Premier Perspective Comparative Hospital Database was conducted to compare RBC transfusion rates in cancer patients receiving EPO or DARB therapy. Study subjects were identified through hospitalizations recorded between 07/2002 and 03/2005 from over 500 hospitals nationwide. Patients were required to be ≥18 years old, have a primary admitting diagnosis of cancer and be treated with EPO or DARB during hospitalization. Patients who had received renal dialysis were excluded. To minimize effects of outliers, 5% of patients with extreme doses in each group were excluded from the dosing analysis. In addition to descriptive statistics on transfusion requirements, a multivariate logistic model was employed to isolate the effect of an individual erythropoietic agent on the risk of RBC transfusion after controlling for patient demographics, comorbidities, admission characteristics, use of IV or oral iron and hospitalization severity markers. Results: Among the 24,814 EPO and 2,990 DARB study patients, mean age and gender distribution at admission were similar (age: EPO 65.3 years, DARB 64.5 years; %women: EPO 53%, DARB 55%). Mean cumulative dose per inpatient stay was EPO 61,656 ± 50,274 Units and DARB 259 ± 340 mcg. RBC transfusions occurred in 37.9% of EPO patients compared to 39.8% of DARB patients (p=0.0404). Transfused EPO patients received a mean of 2.24 units versus 2.20 units for DARB patients (p=0.2111). After adjusting for covariates, the multivariate model confirmed that DARB treatment was associated with a higher risk of transfusion compared to EPO (odds ratio: 1.2, 95% CI: 1.1–1.3, p=0.0007). Conclusions: This analysis of inpatients with cancer indicates DARB treatment is associated with a higher risk of receiving RBC transfusion compared to treatment with EPO. [Table: see text]

Erythropoiesis stimulating agent (ESA) administration at Hb <10 g/dL for chemotherapy-induced anemia (CIA) following the National Coverage Decision (NCD)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20627-e20627
Author(s):  
S. A. Hulnick ◽  
G. Hess ◽  
J. Hill ◽  
H. N. Viswanathan ◽  
R. J. Nordyke
Keyword(s):  
Retrospective Analysis ◽  
Cancer Patients ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Darbepoetin Alfa ◽  
Epoetin Alfa ◽  
Coverage Decision ◽  
Medicare Coverage

e20627 Background: Medicare coverage of ESA treatment for CIA was changed in 7/07 to a hemoglobin (Hb) < 10 g/dL prior to administration. We describe the proportion of ESA administrations at Hb < 10 g/dL over four quarters following the NCD. Methods: A retrospective analysis of ESA administrations from 7/07 - 6/08 using Varian and Impac electronic medical records for 304,654 cancer patients from 91 practice sites across 19 states. Episodes of ESA treatment were identified within chemotherapy episodes. A > 42 day gap in ESA use identified a completed ESA episode and a > 90 day gap in chemotherapy identified a chemotherapy episode. Hb ≤ 7 days prior to ESA administration date was identified for each ESA episode. The percent of ESA administrations at Hb < 10 g/dL was measured from Q3 07 to Q2 08 for darbepoetin alfa (DA) and epoetin alfa (EA) stratified by age. Results: For patients age ≥ 65, the percent of ESAs administered at Hb < 10 g/dL increased from Q3 07 to Q2 08 for initial and maintenance administrations. A less pronounced trend was observed in patients age < 65. Maintenance administrations at Hb < 10 g/dL in patients age < 65 were significantly lower for EA vs. DA. Conclusions: ESA administrations have been increasingly administered at Hb < 10 g/dL. A higher proportion of Medicare-eligible patients received maintenance ESA administrations at Hb < 10 g/dL. [Table: see text] [Table: see text]

About the infrequent thrombotic events during erythropoietin therapy of anemic ovarian cancer patients with chemotherapy

2007 ◽  
Vol 148 (44) ◽  
pp. 2081-2085
Author(s):  
Ottó Lehoczky ◽  
Tamás Pulay
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Darbepoetin Alfa ◽  
Epoetin Alfa ◽  
Epoetin Beta

Bevezetés: A daganatos betegek kemoterápiája kapcsán fellépő anémia miatt adott erythropoetin-kezelések ritka velejárója a trombózis. Az epoetint gyártó cégek valamennyi ilyen készítmény ismertetőjében felhívják a figyelmet erre az esetleges mellékhatásra. Cél: A petefészekrákos betegek kemoterápiája kapcsán adott epoetinkezelések során fellépő thromboticus események áttekintése. Anyag és módszer: Az Országos Onkológiai Intézet Nőgyógyászati osztályán a 2000 és 2006 közötti időszakban 275 petefészekrákos beteg közül 52 kapott epoetin-alfa, 157 epoetin-béta, 66 beteg pedig darbepoetin-alfa-kezelést. A betegek életkora medián 60 (szélső értékek 22, 84) év volt. Eredmény: A 275 közül 1 betegben epoetin-alfa-, 2 betegben pedig epoetin-béta-kezelés kapcsán figyeltek meg thromboticus eseményt (3/275 = 1,1%). A kialakult trombózisok és az epoetinkezelés közötti egyértelmű okozati összefüggést igazolni nem sikerült. Következtetés: A nagy irodalmi metaanalízisekkel megegyezően a szerzők beteganyagában is csak igen ritka a kezelés kapcsán fellépett trombózis.

scholarly journals Darbepoetin versus Epoetin Alfa for the Correction of Anemia in Cancer Patients Receiving Radiotherapy or Chemoradiotherapy Treatment

2008 ◽  
Vol 2 ◽  
pp. CMO.S510 ◽  
Author(s):  
Pilar M Samper Ots ◽  
Concepción López Carrizosa ◽  
Aurora Rodríguez Pérez ◽  
Juan De Dios Saez Garrido ◽  
José M Delgado Pérez
Keyword(s):  
Cancer Patients ◽  
Darbepoetin Alfa ◽  
Study Drug ◽  
Tumor Type ◽  
Epoetin Alfa ◽  
Endogenous Erythropoietin ◽  
The Mean ◽  
Group 2 ◽  
Intent To Treat ◽  
Group 1

Introduction Anemia is the most frequent hematological disturbance in cancer patients, with prevalence between 30% and 90%, depending on the type of tumor, the antitumor treatment, and other factors (infection, malnutrition, bleeding, tumor infiltration of the bone marrow). A number of erythropoietic agents have shown to be effective in increasing the hemoglobin (Hb) levels, reducing the requirements for transfusion, and improving quality of life. The objective of this study is to compare darbepoetin alfa and epoetin alfa when used to correct anemia in cancer patients who are receiving radiotherapy or radiochemotherapy. Material and methods A prospective study of 125 consecutive patients with anemia (Hb < 13 g/dL in males or < 12 g/dL in females) who were undergoing treatment with radiotherapy (RT) or radiochemotherapy (RCT) in our department were enrolled between March 2003 and March 2005. The treatment for the anemia was either darbepoetin alfa 150 mcg/week (62 patients, group 1) or epoetin alfa 40,000 IU/week (63 patients, group 2). Patients received iron supplements in both groups. Treatment was administered in a consecutive manner depending on tumor type. If the increase in Hb was < 1 g/dL after 4 weeks of treatment, the dose was increased to 300 mcg/week in group 1 or to 60,000 IU/week in group 2. The treatment was terminated when a Hb value of ≥ 15 g/dL was reached during RT treatment, a Hb value of ≥ 14 g/dL was reached if the RT had been completed, or after 16 weeks of treatment whatever the Hb value. The mean age of patients was 63.36 ± 11.27 years, 67% were male. No significant differences were observed between the 2 groups in tumor type or stage, previous treatments, or intent to treat with RT or RCT. Results Comparing group 1 and group 2 by intent to treat, the mean Hb at the start of treatment with the study drug was 12.1 g/dL vs 11.8 g/dL, the proportion of patients whose dose was increased was19.7% vs 24.6%, the need for transfusion was 3.2% in each group, the duration of erythropoietic treatment was 6.5 weeks in both groups, and 2 patients in group 2 restarted treatment with epoetin alfa. The percentage of patients who responded (defined as an increase in the Hb ≥ 2 g/dL in the absence of transfusions) was of 72.6% and 66.7%, respectively. Four vascular adverse events were observed, 2 in each group. No significant differences were observed with respect to the baseline, week 4, and week 12 levels of endogenous erythropoietin, serum iron,% saturation, and ferritin. The increase in Hb 1 month after the final administration of the study drug was 2.21 g/dL in group 1 and 2.46 g/dL in group 2 (p = ns). Conclusions The results of our study demonstrate that both treatments are equally effective in correcting anemia in cancer patients undergoing RT or RCT.

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