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Clinical and economic impact of epoetin in adjuvant-chemotherapy for breast cancer

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Abstract

Introduction

Anaemia is a common toxicity in cancer patients and epoetins (EPOs) are now an established treatment. The economic profile of EPO treatment was assessed in patients with breast cancer treated by adjuvant-chemotherapy.

Materials and methods

Two strategies were compared: without treatment by EPO and with the possible use of treatment by EPO (epoetin alfa) when required. The clinical effectiveness criterion was time adjusted to quality of life and economic data included only direct medical costs.

Main results

One hundred ninety-two patients were included. In the group with the strategy containing the possible use of EPO, 45.5% of patients effectively received EPO. A significant difference in the haemoglobin level profile over time was observed which provided a significant overall benefit of 0.0052 (p<10−4) quality-adjusted life year (QALY) associated with an extra cost of €1,615 (p<10−4). In the base case analysis, the cost per added QALY was estimated as €310,577 with the strategy containing the possible use of EPO.

Conclusion

This robust result seems to be unacceptable, but the only relevant point of discussion might be the level of acceptable incremental cost-effectiveness ratio (ICER) for a patient.

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References

  1. Abels R (1993) Erythropoietin for anaemia in cancer patients. Eur J Cancer 29A:S2–S8

    Article  PubMed  Google Scholar 

  2. Baltussen R, Leidl R, Ament A (1999) Real world designs in economic evaluation. Bridging the gap between clinical research and policy-making. PharmacoEconomics 16:449–458

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  4. 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 23:183–192

    Article  PubMed  Google Scholar 

  5. 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 40:2201–2216

    Article  PubMed  CAS  Google Scholar 

  6. Cascinu S, Fedeli A, Del Ferro E, Luzi FS, Catalano G (1994) Recombinant human erythropoïetin treatment in cisplatin-associated anaemia: a randomized, double-blind trial with placebo. J Clin Oncol 12:1058–1062

    PubMed  CAS  Google Scholar 

  7. Cella D (1998) Factors influencing QOL in cancer patients: anaemia and fatigue. Semin Oncol 25:43–46

    PubMed  CAS  Google Scholar 

  8. Chang J, Couture F, Young S, Mc Watters KL, Lau CY (2005) Weekly epoetin alfa maintains haemoglobin, improves quality of life, and reduces transfusion in breast cancer patients receiving chemotherapy. J Clin Oncol 23:2597–2605

    Article  PubMed  CAS  Google Scholar 

  9. Crawford J, Cella D, Cleeland CS, Cremieux PY, Demetri GD, Sarokahn BJ, Slavin MB, Glaspy JA (2002) Relationship between changes in haemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy. Cancer 95:888–895

    Article  PubMed  CAS  Google Scholar 

  10. Cremieux PY, Finkelstein SN, Berndt ER, Crawford J, Slavin MB (1999) Cost effectiveness, quality adjusted life-years and supportive care. PharmacoEconomics 16:459–472

    Article  PubMed  CAS  Google Scholar 

  11. Demetri GD, Kris M, Wade J, Degos L, Cella D (1998) Quality of life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. J Clin Oncol 16:3412–3425

    PubMed  CAS  Google Scholar 

  12. Denison U, Baumann J, Peters-Engl C, Samonigg H, Krippl P, Lang A, Obermair A, Wagner H, Sevelda P (2003) Incidence of anaemia in breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat 79:347–353

    Article  PubMed  CAS  Google Scholar 

  13. Earle CC, Chapman RH, Baker CS, Bell CM, Stone PW, Sandberg EA, Neumann PJ (2000) Systematic overview of cost-utility assessments in oncology. J Clin Oncol 18:3302–3317

    PubMed  CAS  Google Scholar 

  14. Fayers P, Hand D (1997) Generalisation from phase III clinical trials: survival, quality of life and health economics. Lancet 350:1025–1027

    Article  PubMed  CAS  Google Scholar 

  15. Glaspy J, Bukowski R, Steinberg D, Taylor C, Tchekmedyian S, Vadhan-Raj S (1997) Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group. J Clin Oncol 15:1218–1234

    PubMed  CAS  Google Scholar 

  16. Glaspy J, Degos L, Dicato M, Demetri GD (2002) Comparable efficacy of epoetin alfa for anemic cancer patients receiving platinium- and non-platinium-based chemotherapy: a retrospective subanalysis of two large, community-based trials. Oncologist 7:126–135

    Article  PubMed  CAS  Google Scholar 

  17. Gyrd-Hansen D (2005) Willingness to pay for a QALY. Theoretical and methodological issues. PharmacoEconomics 23:423–432

    Article  PubMed  Google Scholar 

  18. Hyland ME (1997) Quality of life measures as providers of information on value for money of health interventions. PharmacoEconomics 11:19–31

    Article  PubMed  CAS  Google Scholar 

  19. Leese B, Hutton J, Maynard A (1992) A comparison of the costs and benefits of recombinant human erythropoietin in the treatment of chronic renal failure in 5 European countries. PharmacoEconomics 1:346–356

    PubMed  CAS  Google Scholar 

  20. Leonard RC, Untch M, Von Koch F (2005) Management of anaemia in patients with breast cancer: role of epoetin. Ann Oncol 16:817–824

    Article  PubMed  CAS  Google Scholar 

  21. Lind M, Vernon C, Cruikshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey -Amante P, Doll H, Wild D (2002) The level of haemoglobin in anaemic cancer patients correlates positively with quality of life. Br J Cancer 86:1243–1249

    Article  PubMed  CAS  Google Scholar 

  22. Littlewood TJ, Bajetta E, Nortier JWR, Vercammen E, Raport for the Epoetin alfa study group (2001) Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving non platinium chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 19:2865–2874

    PubMed  CAS  Google Scholar 

  23. Ludwig GB, Barnett-Lee P, Krzakowski M (2002) Prevalence and management of anaemia in patient with hematologic malignancies and solid tumors: results from the European Cancer Anaemia Survey. Blood 100:234a–235a, Abstract 884

    Google Scholar 

  24. Ludwig H, Fritz E, Leitgeb C, Krainer M, Kuhrer I, Sagaster P, Umek H (1993) Erythropoïetin treatment for chronic anaemia of selected haematological malignancies and solid tumors. Ann Oncol 4:161–167

    PubMed  CAS  Google Scholar 

  25. Marchetti M, Barosi G (2004) Clinical and economic impact of epoetins in cancer care. PharmacoEconomics 22:1029–1045

    Article  PubMed  CAS  Google Scholar 

  26. Oberhoff C, Neri B, Amadori D, Petry KU, Gamucci T, Rebmann U, Nowrousian MR, Voigtmann R, Monfardini S, Armand JP, Herrmann R, Netter-Pinon J, Tubiana-Mathieu N, Zwierzina H (1998) Recombinant human erythropoïetin in the treatment of chemotherapy-induced anaemia and prevention of transfusion requirement associated with solid tumors: a randomised controlled study. Ann Oncol 9:255–260

    Article  PubMed  CAS  Google Scholar 

  27. Rizzo JD, Lichtin AE, Woolf SH, Seidenfeld J, Bennett CL, Cella D, Djulbegovic B, Goode MJ, Jakubowski AA, Lee SJ, Miller CB, Rarick MU, Regan DH, Browman GP, Gordon MS (2002) Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Haematology. J Clin Oncol 20:4083–4107

    Article  PubMed  CAS  Google Scholar 

  28. Spaeth D, Casadevall N, Daouphars M, Marchal C, Marec-Berard P, Fabre N, Haugh M (2004) Summary version of the standards, options and recommendations for the use of recombinant erythropoietin (epoietin-alpha and beta, darbepoietin-alpha, EPO) in the management of anaemia in oncology-Update 2003. Bull Cancer 91:179–188

    PubMed  Google Scholar 

  29. Whittington R, Barradell LB, Benfield P (1993) Epoetin: a pharmacoeconomic review of its use in chronic renal failure and its effects on quality of life. PharmacoEconomics 3:45–82

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

This study has been carried out without external funding. There is no potential conflict of interest that might be relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, University Hospital of Besançon, Hospital J. MINJOZ, Boulevard Fleming, 25030, Besançon Cedex, France

    Philippe Fagnoni, Samuel Limat, Stéphanie Briaud & Marie-Christine Woronoff-Lemsi

  2. INSERM, EPI 106, DIJON, F-21000, Univ Bourgogne, 21000, Dijon, France

    Samuel Limat

  3. Department of Oncology, University Hospital of Besançon, 25030, Besançon Cedex, France

    Loïc Chaigneau, Emmanuel Guardiola, Stéphanie Briaud & Xavier Pivot

  4. Public Health Insurance-Regional Direction of the Medical Department, 21000, Dijon, France

    Bernard Schmitt

  5. Department of Oncology, Loire Cancer Institute, 42270, Saint Etienne, France

    Yacine Merrouche

  6. INSERM, U 645 EA-2284 IFR-133, Univ Franche-Comte, 25000, Besançon, France

    Philippe Fagnoni & Marie-Christine Woronoff-Lemsi

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  1. Philippe Fagnoni
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Correspondence to Samuel Limat.

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Fagnoni, P., Limat, S., Chaigneau, L. et al. Clinical and economic impact of epoetin in adjuvant-chemotherapy for breast cancer. Support Care Cancer 14, 1030–1037 (2006). https://doi.org/10.1007/s00520-006-0062-5

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  • DOI: https://doi.org/10.1007/s00520-006-0062-5

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