COST OF MANAGING ANEMIA WITH AND WITHOUT PROPHYLACTIC EPOETIN ALPHA THERAPY IN BREAST-CANCER PATIENTS RECEIVING COMBINATION CHEMOTHERAPY

The cost of managing anemia with prophylactic epoetin alfa therapy ver sus blood transfusions in breast cancer patients receiving combination chemotherapy was studied. A retrospective study of anemia in breast c ancer patients treated with four cycles of cyclophosphamide and doxoru bicin with fluorouracil (CAF) or without fluorouracil (CA) was conduct ed. For each cycle of chemotherapy, patients were assessed for fatigue , subsequent blood transfusions administered, and potential response t o and adverse effects of blood transfusions. Transfusions were given a t the prescriber's discretion rather than in accordance with standard guidelines. The lowest hemoglobin concentration and hematocrit for eac h patient per cycle were reported. Data on these patients, along with data from published studies of prophylactic use of epoetin alfa, were used in a decision analysis of the costs associated with using epoetin alfa versus red blood cell transfusions to manage anemia. The charts of 50 patients were reviewed. In the study group, the percentage of pa tients with anemia and the frequency of fatigue rose with each chemoth erapy cycle. In general, blood transfusions were not used. The cost of using epoetin alfa prophylactically for all four cycles was estimated at $6483 per patient for the literature-based group versus $169 for t he study group. The cost of managing anemia in breast cancer patients was substantially lower when blood transfusions were used than when ep oetin alfa was given prophylactically throughout four cycles of therap y with CAF or CA; the absence of standard guidelines for transfusion m ight have exaggerated the difference in costs.