Skip to main content

Abstract

It may seem strange that the efficacy of erythropoietins in treating cancer related anaemia was decided beyond doubt in 1995 yet more than a decade later there is still debate about whether they are cost-effective. In 1995, cumulative meta-analysis reviewing randomised trials against date of trial completion showed an unequivocal positive effect (Clark 2002). Health economic study is an evolving area of medicine. In contrast to the familiar standard format of phase I, II and III clinical trials, there is no agreed methodology or unequivocal definition of a positive or negative result. This may seem frustrating to haematologists and oncologists, but the importance of reimbursement and economic appraisal in determining patients’ access to treatment makes this an important area of erythropoietin and anaemia research.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Agency for Healthcare Research and Quality, Rockville, MD: Calculating the U.S. Population-based EQ-5D Index Score. August 2005. http://www.ahrq.gov/ rice/EQ5Dscore.htm

    Google Scholar 

  2. Agrawal S, Davidson N, Walker M, Gibson S, Lim C, Morgan CL, Cowell W (2006) Assessing the total costs of blood delivery to hospital oncology and haematology patients. Curr Med Res Opin 22(10): 1903–1909

    Article  PubMed  Google Scholar 

  3. Allain J-P (2003) Transfusion risks of yesterday and of today. Transfus Clin Biol 10: 1–5

    Article  PubMed  Google Scholar 

  4. Ament AJ (1993) Allocation of scarce resources: the limitations of cost per Qaly. Abstr Int Soc Technol Assess Health Care Meet 9: 57

    Google Scholar 

  5. Anderson GF, Frogner BK, Johns RA, Reinhardt UE (2006) Health care spending and use of information technology in OECD countries. Health Affairs 25(89): 819–831

    Article  PubMed  Google Scholar 

  6. Appleby J (2001) Health insurance prices to soar. USA TODAY 08/27/2001

    Google Scholar 

  7. ASInsights. Erythropoietin: Current market dynamics and future outlook. Publisher: ASInsights Available for download as a PDF at http://www. pharmainstitute.com/coms2/summary_0283-1335_ITM (accessed 2007 may 8)

    Google Scholar 

  8. Barnett A, Birnbaum H, Cremieux PY, Fendrick AM, Slavin M (2000) The costs of cancer to a major employer in the United States: a case-control analysis. Am J Manag Care 6(11): 1243–1251

    CAS  PubMed  Google Scholar 

  9. Barnett A, Cremieux PY, Fendrick AM, et al (2002) Anemia related costs for cancer patients. J Manag Care Med 6: 20–28

    Google Scholar 

  10. Barosi G, Marchetti M, Liberato NL (1998) Cost-effectiveness of recombinant human erythropoietin in the prevention of chemotherapy-induced anaemia. Br J Cancer 78(6): 781–787

    CAS  PubMed  Google Scholar 

  11. Barrett-Lee PJ, Bailey NP, O’Brien ME, Wager E (2000) Large-scale UK audit of blood transfusion requirements and anaemia in patients receiving cytotoxic chemotherapy. Br J Cancer 82(1): 93–97

    Article  CAS  PubMed  Google Scholar 

  12. Bell CM, Urbach DR, Ray JG, Bayoumi A, Allison B Rosen AB, Greenberg D, Neumann PJ (2006) Bias in published cost effectiveness studies: systematic review. BMJ 332: 699–703

    Article  PubMed  Google Scholar 

  13. Berndt E, Crown W, Kallich J, Long S, Song X, Lyman GH (2005) The impact of anaemia and its treatment on employee disability and medical costs. Pharmacoeconomics 23(2): 183–192

    Article  PubMed  Google Scholar 

  14. Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J, Trelle S, Weingart O, Bayliss S, Djulbegovic B, Bennett CL, Langensiepen S, Hyde C, Engert A (2006) Recombinant Human Erythropoietins and Cancer Patients: Updated Meta-Analysis of 57 Studies Including 9353 Patients. JNCI Journal of the National Cancer Institute 98(10): 708–714

    Article  CAS  Google Scholar 

  15. Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J, Trelle S, Weingart O, Bayliss S, Brunskill S, Djulbegovic B, Benett CL, Langensiepen S, Hyde C, Engert E (2006) Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev 3: CD003407

    CAS  PubMed  Google Scholar 

  16. Bokemeyer C, Aapro MS, Courdi A, Foubert J, Link H, Osterborg A, Repetto L, Soubeyran P (2004) EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer 40(15): 2201–2216

    Article  CAS  PubMed  Google Scholar 

  17. Bokemeyer C, Aapro MS, Courdi A, Foubert J, Link H, Osterborg A, Repetto L, Soubeyran P (2004) EORTC guidelines for the use of erythropoietic proteins in anaemic patients with cancer. Eur J Cancer 40(15): 2201–2216

    Article  CAS  PubMed  Google Scholar 

  18. Bosanquet N, Tolley K (2003) Treatment of anaemia in cancer patients: implications for supportive care in the National Health Service Cancer Plan. Curr Med Res Opin 19(7): 643–650

    Article  PubMed  Google Scholar 

  19. Bottomley A, Thomas R, Van Steen K, Flechtner H, de Graeff A (2003) Guidelines for the use of Epoetin: Have Quality-of-life benefits been proven? JCO Jun 1: 2223

    Article  Google Scholar 

  20. Busschbach JJV, Hessing DJ, de Charro FT (1993) The utility of health at different stages in life: A quantitative approach, Social Science & Medicine 37(2): 153–15821.

    Article  CAS  Google Scholar 

  21. Cancer Care Ontario Practice Guidelines Initiative (The Role of Erythropoietin in the Management of Cancer Patients with Non-Hematologic Malignancies Receiving Chemotherapy (Practice Guideline #12-1) (Version 2.2003)

    Google Scholar 

  22. Danish Centre for Evaluation and Health Technology. Epoetin (EPO) for Anaemic Cancer Patients — A Rapid Assessment. Health Technology Assessment 2004; 6(1) (available online at www.sst.dk/publ/Publ2004/CEMTV_eng/epo_ 1805.pdf)

    Google Scholar 

  23. Cavill I (2002) Reducing blood transfusion. Focus should be on improving patients’ ability to make own blood. BMJ 21;325(7365): 655

    Google Scholar 

  24. Chapman RH, Berger M, Weinstein MC, Weeks JC, Goldie S, Neumann PJ (2004) When does quality-adjusting life-years matter in cost-effectiveness analysis? Health Econ 13(5): 429–436

    Article  PubMed  Google Scholar 

  25. Chaves PHM, Mody SH, Najib MM, Siegartel LR, Blasi MV, Woodman RC (2003) Anemia in the elderly is associated with increased healthcare costs and resource utilization. Blood 102: abstract 2769

    Google Scholar 

  26. Clark O (2002) Erythropoietin, uncertainty principle and cancer related anaemia. BMC Cancer 24;2(1): 23

    Article  Google Scholar 

  27. Cremieux PY, Barrett B, Anderson K, Slavin MB (2000) Cost of outpatient blood transfusion in cancer patients. J Clin Oncol 18(14): 2755–2761

    CAS  PubMed  Google Scholar 

  28. Demarteau N, Annemans L, Mossman T, Bracco A (2007) Cost-effectiveness of darbepoetin alfa (DA) 500*T*mcg every three weeks (Q3W) with IV iron compared to DA Q3W alone in cancer patients (pts) with chemotherapy-induced anaemia (CIA). J Clin Oncol 2007 ASCO Annual Meeting Proceedings (Post-Meeting Edition) 25 (18S) (June 20 Supplement): 19531

    Google Scholar 

  29. Devlin N, Parkin D (2004) Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Economics 13(5): 437–452

    Article  PubMed  Google Scholar 

  30. Dewilde S, Turk F, Tambour M, Sandström T (2006) The economic value of anti-IgE in severe persistent, IgE-mediated (allergic) asthma patients: adaptation of INNOVATE to Sweden. Curr Med Res Opin 22(9): 1765–1776.

    Article  CAS  PubMed  Google Scholar 

  31. Donaldson L (2004) On the state of the public health: Annual report of the Chief Medical Officer 2003. UK Department of Health, 28 July 2004

    Google Scholar 

  32. Drummond MF, O’Brien B, Stoddart GL, Torrance GW (1997) Methods for the Economic Evaluation of Health Care Programmes. 2. Oxford Medical Publications, Oxford

    Google Scholar 

  33. Eichler H-G, Kong SX, Gerth WC, Mavros P, Jönsson P (2004) Use of costeffectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value in Health 7(5): 518–528

    Article  PubMed  Google Scholar 

  34. Erickson P, Wilson R, Shannon I (1995) Years of healthy life. Healthy People 2000 Statistical Notes. Atlanta (GA): Centers for Disease Control and Prevention

    Google Scholar 

  35. Evans C, Tavakoli M, Crawford B (2004) Use of quality adjusted life years and life years gained as benchmarks in economic evaluations: a critical appraisal. Health Care Manage Sci 7: 43–49

    Article  Google Scholar 

  36. Forbes JM, Anderson MD, Anderson GF, Bleecker GC, Rossi EC, Moss GS (1991) Blood transfusion costs: a multicenter study. Transfusion 31(4): 318–323

    Article  CAS  PubMed  Google Scholar 

  37. Greenhalgh T (1997) How to read a paper: papers that tell you what things cost (economic analyses). BMJ 315: 596–599

    CAS  PubMed  Google Scholar 

  38. Gustafson DH, Helstad CP, Hung CF, Nelson G, Batalden P (1995) The total costs of illness: a metric for health care reform. Hosp Health Serv Adm 40(1): 154–171

    CAS  PubMed  Google Scholar 

  39. Hedenus M, Vansteenkiste J, Kotasek D, Austin M, Amado RG (2005) Darbepoetin alfa for the treatment of chemotherapy-induced anemia: disease progression and survival analysis from four randomized, double-blind, placebocontrolled trials. J Clin Oncol 23(28): 6941–6948

    Article  CAS  PubMed  Google Scholar 

  40. Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 20(3): 332–342

    Article  CAS  PubMed  Google Scholar 

  41. Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 20: 332–342

    Article  CAS  PubMed  Google Scholar 

  42. Hogerzeil HV (2004) BMJ 329: 1169

    Article  PubMed  Google Scholar 

  43. Johnson JA, et al (1998) Valuation of EuroQOL (EQ-5D) health states in an adult US sample. Pharmacoeconomics 13: 421–433

    Article  CAS  PubMed  Google Scholar 

  44. Johnson J A, Coons SJ (1998) Comparison of the EQ-5D and SF-12 in an adult US sample Quality of Life Research 7(2): 155–166

    Article  CAS  PubMed  Google Scholar 

  45. Kapp KS, Poschauko J, Geyer E, Berghold A, Oechs AC, Petru E, Lahousen M, Kapp DS (2002) Evaluation of the effect of routine packed red blood cell transfusion in anemic cervix cancer patients treated with radical radiotherapy. Int J Radiat Oncol Biol Phys 54(1): 58–66

    PubMed  Google Scholar 

  46. Kassirer JP, Angell M (1994) The journal’s policy on cost-effectiveness analyses. N Engl J Med 331: 669–670

    Article  CAS  PubMed  Google Scholar 

  47. Kind P (1996) The EuroQol instrument: An index of health-related quality of life. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials, 2nd edition. Lippincott-Raven Publishers, Philadelphia, pp 191–201

    Google Scholar 

  48. Kushner JP, Porter JP, Olivieri NF (2001) Secondary iron overload. American Society of Hematology Education Program Book 2001, 1: 47–61

    Google Scholar 

  49. Latief K (2004) Cancer 2025 report, in Cancer Services Insight. 2004 Autumn, p8

    Google Scholar 

  50. Littlewood T, Zambrowski J-J, Cornes P (2006) Curent Medical Research & Opinion 22(s4): s23–s34

    Article  Google Scholar 

  51. Ludlam CA, Turner ML (2006) Managing the risk of transmission of variant Creutzfeldt Jakob disease by blood products. Br J Haematol 132: 13–24

    Article  PubMed  Google Scholar 

  52. Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, Kosmidis P, Krzakowski M, Nortier J, Olmi P, Schneider M, Schrijvers D (2004) The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer 40: 2293–2306

    Article  PubMed  Google Scholar 

  53. Lurie P, Almeida CM, Stine N, Stine AR, Wolfe SM (2006) Financial conflict of interest disclosure and voting patterns at Food and Drug Administration Drug Advisory Committee meetings. JAMA 295(16): 1921–1928

    Article  CAS  PubMed  Google Scholar 

  54. Lyman GH, Berndt ER, Kalich JD, et al (2005) The economic burden of anemia in cancer patients receiving chemotherapy. Value Health 8: 149–156

    Article  PubMed  Google Scholar 

  55. Martin S, Rice N, Smith PC (2007) The link between healthcare spending and health outcomes Evidence from English programme budgeting data. Centre for Health Economics, University of York, Published by: The Health Foundation, 90 Long Acre, London WC2E 9RA, June 2007

    Google Scholar 

  56. McGregor M (2003) Cost-utility analysis: use QALYs only with great caution. CMAJ 168(4): 433–434

    PubMed  Google Scholar 

  57. Miners AH, Garau M, Fidan D, Fischer AJ (2005) Comparing estimates of cost effectiveness submitted to the National Institute for Clinical Excellence (NICE) by different organisations: retrospective study. BMJ 330: 65

    Article  CAS  PubMed  Google Scholar 

  58. Mohandas K, Aledort L (1995) Transfusion requirements, risks, and costs for patients with malignancy. Transfusion 35: 427–430

    Article  CAS  PubMed  Google Scholar 

  59. Mortimer PP (2002) Making blood safer. BMJ 325: 400–401

    Article  PubMed  Google Scholar 

  60. NICE. Anaemia (cancer-treatment induced) — erythropoietin (alpha and beta) and darbepoetin: Appraisal consultation document. 29 Jun 2007 [web ref http://guidance.nice.org.uk/page.aspx?o=439014]

    Google Scholar 

  61. Nissenson AR, Wade S, Goodnough T, Knight K, Dubois RW J (2005) Economic burden of anemia in an insured population. Manag Care Pharm 11(7): 565–574

    Google Scholar 

  62. Österborg A (1998) Recombinant human erythropoietin (rHuEPO) therapy in patients with cancer-related anaemia: what have we learned? Med Oncol 15 [Suppl 1]: S47–S49

    PubMed  Google Scholar 

  63. Ortega A, Dranitsaris G, Puodziunas AL (1998) What are cancer patients willing to pay for prophylactic epoetin alfa? A cost-benefit analysis. Cancer 83(12): 2588–2596

    Article  Google Scholar 

  64. Penninx BW, Pahor M, Woodman RC, Ferrucci L, Guralnik JM (2003) Late-life anemia identifies persons at risk for mortality and hospitalization. Blood 102: abstract 881

    Article  Google Scholar 

  65. Pirker R, Wiesenberger K, Pohl G, Minar W (2003) Anemia in lung cancer: clinical impact and management. Clin Lung Cancer 5: 90–97

    Article  PubMed  Google Scholar 

  66. Provan D (1999) Better blood transfusion. BMJ 318: 1435–1436

    CAS  PubMed  Google Scholar 

  67. Reinhardt UE, Hussey PS, Anderson GF (2004) U.S. Health Care Spending In An International Context. Health Affairs 23(3): 10–25

    Article  PubMed  Google Scholar 

  68. Reinhardt UE, Hussey PS, Anderson GF, U.S. (2004) Health care spending in an international context. Health Affairs 2(3): 10–25

    Article  Google Scholar 

  69. Remak E, Hutton J, Jones M, Zagari M (2003) Changes in cost-effectiveness over time. The case of Epoetin Alfa for renal replacement therapy patients in the UK. Eur J Health Econ 4(2): 115–121

    Article  CAS  PubMed  Google Scholar 

  70. Sandler SG, Yu H, Rassai N (2003) Risks of blood transfusion and their prevention. Clin Adv Hematol Oncol 1: 307–313

    PubMed  Google Scholar 

  71. Seidenfeld J, Piper M, Flamm C, Hasselblad V, Armitage JO, Bennett CL, Gordon MS, Lichtin AE, Wade JL 3rd, Woolf S, Aronson N (2001) Epoetin treatment of anemia associated with cancer therapy: a systematic review and metaanalysis of controlled clinical trials. J Natl Cancer Inst 93(16): 1204–1214

    Article  CAS  PubMed  Google Scholar 

  72. Sheffield R, Sullivan SD, Saltiel E, Nishimura L (1997) Cost comparison of recombinant human erythropoietin and blood transfusion in cancer chemotherapy-induced anemia. Ann Pharmacother 31(1): 15–22

    CAS  PubMed  Google Scholar 

  73. Sheldon T (2006) Dutch consider excluding costly treatments from health insurance. BMJ 333: 113 (Zinnige en duurzaame zorg (Sensible and Lasting Care), is available in Dutch at www.rvz.net)

    Article  PubMed  Google Scholar 

  74. Straus DJ, Testa M, Riggs SA, Tulpule A, Sarokhan B (2003) Early Treatment with Epoetin Alfa Improves Anemia, Quality of Life (QOL), and Productivity in Patients (Pts) with Hematologic Malignancies and Mild Anemia during Chemotherapy (CT). Blood 102(11): A1811

    Google Scholar 

  75. Straus DJ, Testa MA, Sarokhan BJ, Czuczman MS, Tulpule A, Turner RR, Riggs SA (2006) Quality-of-life and health benefits of early treatment of mild anemia: a randomized trial of epoetin alfa in patients receiving chemotherapy for hematologic malignancies. Oc 107(8): 1909–1917

    CAS  Google Scholar 

  76. Tanne JH (2006) Number of uninsured middle class US citizens grows. BMJ 332: 1047

    PubMed  Google Scholar 

  77. Tengs TO (2004) Cost-effectiveness versus cost-utility analysis of interventions for cancer: does adjusting for health-related quality of life really matter? Value Health 7(1): 70–78

    Article  PubMed  Google Scholar 

  78. Tuffs A (2006) German law to cuts drug costs angers doctors. BMJ 332: 1051

    Article  Google Scholar 

  79. Ubel PA (2003) What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med (163): 1640–1641

    Article  Google Scholar 

  80. Vaupel P, Thews O, Mayer A, Höckel S, Höckel M (2002) Oxygenation status of gynecologic tumors: what is the optimal hemoglobin level? Strahlenther Onkol 178(12): 727–731

    Article  PubMed  Google Scholar 

  81. Vogelzang NJ, et al (1997) Semin Hematol 34 [Suppl 2]: 4–12

    CAS  PubMed  Google Scholar 

  82. Wang AJ (1998) Key concepts in evaluating outcomes of ATP funding of medical technologies. J Technol Transfer 23(2): 61–65.

    Article  Google Scholar 

  83. Wilking N, Jönsson B (2005) A pan-European comparison regarding patient access to cancer drugs. Stockholm, Sweden, Karolinska Institutet in collaboration with Stockholm School of Economics, 2005

    Google Scholar 

  84. Wilking N, Jonsson B (2005) A Pan European comparison regarding patient access to cancer drug, Karolinska Institute and Stockholm School of Economics, Stockholm, Sweden 2005, p12

    Google Scholar 

  85. Wilson J, Yao GL, Raftery J, Bohlius J, Brunskill S, Sandercock J, Bayliss S, Moss P, Stanworth S, Hyde C (2007) A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment. Health Technol Assess 11(13): 1–220

    CAS  PubMed  Google Scholar 

  86. Wilson J, Yao GL, Raftery J, Bohlius J, Brunskill S, Sandercock J, Bayliss S, Moss P, Stanworth S, Hyde C (2007) A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment. Health Technol Assess 11(13): 1–220

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul Cornes .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag/Wien

About this chapter

Cite this chapter

Cornes, P. (2008). Cost-effectiveness of treating cancer anaemia. In: Nowrousian, M.R. (eds) Recombinant Human Erythropoietin (rhEPO) in Clinical Oncology. Springer, Vienna. https://doi.org/10.1007/978-3-211-69459-6_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-211-69459-6_34

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-25223-9

  • Online ISBN: 978-3-211-69459-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics