Cast effectiveness, quality-adjusted life-years and supportive care - Recombinant human erythropoietin as a treatment of cancer-associated anaemia

Objective: To measure the cost effectiveness of a supportive care intervent ion when the no-treatment option is unrealistic in an analysis of recombina nt human erythropoietin (epoetin) treatment for anaemic patients with cance r undergoing chemotherapy. Further, to assess whether quality-adjusted life -years (QALYs) can provide the basis for an appropriate measure of the valu e 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 p atients with cancer who were treated with chemotherapy, radiotherapy, epoet in and blood transfusions as needed under standard care for patients with c ancer. Main outcome measures and results: When compared with transfusions, epoetin is cost effective under varying assumptions, whether effectiveness is meas ured by haemoglobin level or quality of life. Specifically, under a base-ca se scenario, the effectiveness resulting from $US1 spent on standard care c an be achieved with only $US0.81 of epoetin care. Due in part to the health -state dependence of the significance patients attach to incremental change s in their responses on the linear analogue scale, cost per QALY results ar e ambiguous in this supportive care context. Conclusions: Under a broad range of plausible assumptions, epoetin can be u sed cost effectively in the treatment of anaemic patients with cancer. Furt her, QALYs have limited applicability here because, as a short term support ive treatment, epoetin enhances the quality but not the length of life. Fut ure research would benefit from the establishment of consistent values for quality-of-life changes across patients and health status, and the extensio n,of the QALY framework to supportive care.