Real-Life Cost Analysis of Anemia Treatment with Erythropoiesis Stimulating Agents In Cancer Patients Receiving Chemotherapy.

In 2008 Spaepen et al. (The Oncologist 2008;13:596–607) published a cost analysis on the treatment of chemotherapy-induced anemia with the different available erythropoiesis stimulating agents (ESA), based on data derived from a Belgian Hospital Disease Database. The objective of this study was to assess the applicability of that analysis in the Austrian setting and to evaluate if there were differences in cost between ESAs.

The original study was performed based on a hospital disease database including 34% of the Belgian hospital beds and day clinic visits. As ESAs can only be provided by the hospital pharmacy, all ESA use in cancer patients was captured. To adapt this database for use in the Austrian setting, it was necessary to adjust for discrepancies regarding the epidemiology and treatment patterns of cancer patients in both countries, as well as the costs of medical care. This was achieved using a mixed-effects model stratifying for propensity score quintiles, as described in Spaepen et al (2008). Data on the following variables were compared between countries and adaptations were performed if necessary: (1) gender and age distribution of the general population; (2) distribution of cancer types; (3) use of chemotherapy; and (4) use of ESAs and blood transfusions. Austrian unit costs (Euro, 2010) where applied to the original resource use data.

The general demographic country profile revealed similarities between Austria and Belgium in terms of average age and gender (41.01 vs. 40.72 average age; 39.48% vs. 39.39% proportion male), and distribution per age. The overall cancer incidence was somewhat lower in the Austrian population (0.45% vs. 0.52%). However, important differences were found in the prevalence of 4 specific cancer types (hematologic, female breast, lung, female genital cancers), which were less present in Austria. Therefore, the relative weight of those cancer types was reduced in the original dataset, based on the prevalence ratios of Austria compared to Belgium [hematologic cancers (0.6377); female breast cancer (0.5102); lung cancer (0.5618); female genital cancer (0.7787)]. In terms of chemotherapy use, IMS Health sales data was used to derive the total use (in mg) of the different molecules for both countries. The ratio of total annual Austrian over total annual Belgian consumption (38%) was calculated per molecule to adjust the analysis for Austria. No major differences were found regarding the use of ESAs or the administration of blood transfusions for chemotherapy patients.

Table 1 and Table 2 present the results of the propensity-score adjusted cost analysis for Austria (Euro, Health Care payer perspective, mean ± se).

By using published epidemiologic and treatment pattern data, it was possible to adapt the Belgian Hospital database to the Austrian population. After adjusting for country differences, the results of the Austrian analysis reflected that patients treated with darbepoetin experienced lower overall costs than patients treated with epoetin-α or epoetin-β. Patients in the darbepoetin group incurred the lowest cost in terms of ESAs used. In terms of anemia-related costs, the overall costs of treatment were lower in patients receiving darbepoetin compared to patients receiving epoetin-α or epoetin-β. These findings are in line with those from the Belgian analysis.

Duran:Amgen: Consultancy. Spaepen:IMS Health: Consultancy. Lamotte:Amgen: Consultancy. Walter:Amgen: Consultancy. Kutikova:Amgen: Employment. Pujol:Amgen: Employment. Annemans:IMS Health: Consultancy.