COST COMPARISON OF RECOMBINANT-HUMAN-ERYTHROPOIETIN AND BLOOD-TRANSFUSION IN CANCER CHEMOTHERAPY-INDUCED ANEMIA

OBJECTIVE: To compare the cost of recombinant human erythropoietin (rH uEPO) with that of blood transfusion in the treatment of chemotherapy- induced anemia from a healthcare system perspective. DESIGN: A decisio n analytic model. Baseline estimates were obtained from a review of cl inical trials data and economic evaluation studies. SUBJECTS: Secondar y data analyses of patients with advanced malignancies, excluding hema tologic malignancies and metastasized solid tumors. INTERVENTIONS: Pat ients received either leukocyte-depleted packed red blood cells (PRBCs ) or rHuEPO 150 units/kg sc three times per week for 6 months (24 wk). After 6 weeks, if rHuEPO recipients did not display a response, they received rHuEPO 300 units/kg sc three times weekly for the duration of therapy. If rHuEPO recipients still exhibited no response, they were given blood transfusions. MEASUREMENTS AND MAIN RESULTS: For a treatme nt period of 24 weeks, approximately 64% of rHuEPO recipients responde d at an average expected cost of $12 971 per patient. One hundred perc ent of transfusion recipients responded at a cost of $4481; this resul ted in a cost savings of $8490. Variation of response rates for rHuEPO or PRBCs did not appreciably lower costs. Lower rHuEPO dosages and hi gher numbers of transfused units of PRBCs yielded approximately equiva lent costs; however, these strategies may not be clinically prudent. C ONCLUSIONS: From a healthcare system cost and outcome perspective, blo od transfusion is the preferred strategy for chemotherapy-induced anem ia. However, rHuEPO may be considered an effective blood-sparing alter native for patients with non-stem cell disorders. Future cost-effectiv eness analyses are needed to assess more completely both the clinical and quality-of-life benefits rHuEPO may contribute to individual patie nts' lives and to society overall.