ESAs (erythropoiesis-stimulating agents) not cost effective in cancer patients with anemia | HemOncToday

Blogger opinion: more concerning than cost is the recent research regarding increased mortality rates with the use of ESAs

"The use of erythropoiesis-stimulating agents to reduce the need for blood transfusions and improve quality of life in cancer patients with anemia was found to be economically unattractive by an analysis using the Canadian public health care system."

Previous work has shown that erythropoiesis-stimulating agents (ESAs) are preferred by patients compared with transfusion and can improve short-term disease-specific quality of life in patients with cancer, but there are concerns over toxicity and cost of the agents. Researchers created a decision analytic model incorporating resource utilization and health outcomes to test the cost-effectiveness of ESA use in patients with anemia related to cancer. Using a model cohort, treatment with epoetin resulted in incremental costs of $8,643 over 15 weeks compared to no ESA use. This gave an incremental cost per quality-of-life-year (QALY) gained of $267,000. Even when a model overemphasizing the potential benefits of ESAs was used, the cost per QALY gained remained greater than $100,000.
Finally, separate analyses were conducted using data from studies that followed the most recent American Society of Hematology/ASCO guidelines for ESA use; these guidelines are more conservative in their recommendations for using ESAs. The results did show lower costs than the base case, but the cost per QALY remained greater than $70,000. In three of 10 models, ESA use had more cost and less benefit than no ESA use.
“ESA use in patients with [anemia related to cancer] does not appear to be economically attractive, even when used in the more conservative fashion recommended by current guidelines,” the researchers wrote. “Available evidence suggests that using ESA to treat anemia related to cancer does not represent a good value for the money.”

link to abstract: 
http://www3.interscience.wiley.com/journal/123359351/abstract?CRETRY=1&SRETRY=0