Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Supportive Care in Cancer
Published in: Supportive Care in Cancer 2/2013

Open Access 01-02-2013 | Original Article

Hemoglobin level at initiation of darbepoetin alfa: impact on need for transfusion and associated costs in chemotherapy-induced anemia treatment in Europe

Authors: Melike Deger, Wolfgang Eisterer, Lucie Kutikova, Sam Salek

Published in: Supportive Care in Cancer | Issue 2/2013

Login to get access

Abstract

Purpose

Erythropoiesis-stimulating agents can reduce red blood cell transfusion rates in patients developing anemia while receiving chemotherapy. We investigated potential cost savings from reduced transfusion rates in patients starting darbepoetin alfa (DA) at higher versus lower hemoglobin (Hb) levels.

Methods

Two systematic literature reviews were performed: transfusion outcomes in patients receiving DA stratified by baseline Hb level and costs of transfusion in Europe. Potential cost savings were calculated by multiplying the difference in transfusion rates between Hb levels by the midpoint of transfusion costs.

Results

Despite differences in baseline characteristics, treatment duration and analysis technique, the clinical studies (n = 8) showed that fewer transfusions were required when DA was initiated at higher versus lower Hb levels. The economic studies (n = 9) showed that 1 unit of transfusion ranged from €130 to €537 (2010-adjusted values). Cost savings from initiating DA at higher versus lower Hb levels were €503–2,226 (2 units transfused) and €880–3,895 (3.5 units) per ten patients.

Conclusions

Transfusion incidence increases with DA initiation at lower Hb levels. Potential cost savings depend on the number of units transfused and cost items included. DA initiation according to guidelines can reduce transfusions and potentially reduce transfusion-associated costs.
Footnotes
1
Patients received DA immediately (Hb ≥10.5 g/dl) or waited until Hb had decreased below 10 g/dl.
 
Literature
1.
Ludwig H, Fritz E (1998) Anemia in cancer patients. Semin Oncol 25(3 Suppl 7):2–6PubMed
2.
Caro JJ, Salas M, Ward A, Goss G (2001) Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer 91:2214–2221PubMedCrossRef
3.
Cella D (1997) The Functional Assessment of Cancer Therapy–Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34(3 Suppl 2):13–19PubMed
4.
Merli F, Bertini M, Luminari S, Mozzana R, Bertè R, Trottini M et al (2004) Quality of life assessment in elderly patients with aggressive non-Hodgkin’s lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi. Haematologica 89:973–978PubMed
5.
Surgenor DM, Wallace EL, Hale SG, Gilpatrick MW (1988) Changing patterns of blood transfusions in four sets of United States hospitals, 1980 to 1985. Transfusion 28:513–518PubMedCrossRef
6.
Aapro MS, Link H (2008) September 2007 update on EORTC guidelines and anemia management with erythropoiesis-stimulating agents. Oncologist 13(Suppl 3):33–36PubMedCrossRef
7.
Schrijvers D, De Samblanx H, Roila F (2010) Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO Clinical Practice Guidelines for use. Ann Oncol 21(Suppl 5):v244–v247PubMedCrossRef
8.
Rizzo JD, Somerfield MR, Hagerty KL, Seidenfeld J, Bohlius J, Bennett CL et al (2008) Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update. J Clin Oncol 26:132–149PubMedCrossRef
9.
Janssen–Cilag Ltd (2010) Eprex 2000, 4000 and 10000 IU/ml solution for injection in pre-filled syringe. Summary of Product Characteristics. Janssen–Cilag Ltd, High Wycombe
10.
Roche Products Ltd (2011) Neorecormon solution for injection in pre-filled syringe. Summary of Product Characteristics. Roche Registration Ltd, Welwyn Garden City
11.
Amgen Ltd (2011) Aranesp PFS. Summary of product characteristics. Amgen Europe BV, Breda
12.
Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB et al. (2012) Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med 157:49–58
13.
Vansteenkiste J, Tomita D, Rossi G, Pirker R (2004) Darbepoetin alfa in lung cancer patients on chemotherapy: a retrospective comparison of outcomes in patients with mild versus moderate-to-severe anaemia at baseline. Support Care Cancer 12:253–262PubMedCrossRef
14.
Egrie JC, Browne JK (2001) Development and characterization of novel erythropoiesis stimulating protein (NESP). Nephrol Dial Transplant 16(Suppl 3):3–13PubMedCrossRef
15.
Vansteenkiste J, Wauters I (2007) Darbepoetin alfa for chemotherapy-induced anemia: evolution to extended dosing intervals. Expert Rev Anticancer Ther 7:1347–1355PubMedCrossRef
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Eisterer W, Hussl C, Erb H, Haslbauer F, Sormann S, Braun S et al (2011) RETRA: evaluating the transfusion rate with darbepoetin alfa 500 microg every 3 weeks in anaemic cancer patients receiving chemotherapy. Curr Med Res Opin 27:355–363PubMedCrossRef
26.
Agrawal S, Davidson N, Walker M, Gibson S, Lim C, Morgan CL et al (2006) Assessing the total costs of blood delivery to hospital oncology and haematology patients. Curr Med Res Opin 22:1903–1909PubMedCrossRef
27.
Glenngård AH, Persson U, Söderman C (2005) Costs associated with blood transfusions in Sweden: the societal cost of autologous, allogeneic and perioperative RBC transfusion. Transfus Med 15:295–306PubMedCrossRef
28.
Gabrilove JL, Perez EA, Tomita DK, Rossi G, Cleeland CS (2007) Assessing symptom burden using the M. D. Anderson symptom inventory in patients with chemotherapy-induced anemia: results of a multicenter, open-label study (SURPASS) of patients treated with darbepoetin-alpha at a dose of 200 microg every 2 weeks. Cancer 110:1629–1640PubMedCrossRef
29.
Boccia R, Malik IA, Raja V, Kahanic S, Liu R, Lillie T et al (2006) Darbepoetin alfa administered every three weeks is effective for the treatment of chemotherapy-induced anemia. Oncologist 11:409–417PubMedCrossRef
30.
Charu V, Saidman B, Ben-Jacob A, Justice GR, Maniam AS, Tomita D et al (2007) A randomized, open-label, multicenter trial of immediate versus delayed intervention with darbepoetin alfa for chemotherapy-induced anemia. Oncologist 12:1253–1263PubMedCrossRef
31.
Mel JR, Salar A, Rodriguez CA, Alegre A, González A, Cassinello J et al (2008) A prospective observational study of the effectiveness, safety, and effect on fatigue of darbepoetin alfa for the treatment of chemotherapy-induced anaemia. Curr Med Res Opin 24:2931–2942PubMedCrossRef
32.
Ludwig H, Crawford J, Osterborg A, Vansteenkiste J, Henry DH, Fleishman A et al (2009) Pooled analysis of individual patient-level data from all randomized, double-blind, placebo-controlled trials of darbepoetin alfa in the treatment of patients with chemotherapy-induced anemia. J Clin Oncol 27:2838–2847PubMedCrossRef
33.
Canon JL, Vansteenkiste J, Hedenus M, Gascon P, Bokemeyer C, Ludwig H et al. (2011) Transfusion risk in cancer patients with chemotherapy-induced anemia when initiating darbepoetin alfa therapy at a baseline hemoglobin level of <9 g/dL versus 9 to <10 g/dL versus ≥10 g/dL: an exploratory analysis of a phase 3 trial. Med Oncol. doi:10.​1007/​s12032-011-0103-x
34.
Malik I, Kahanic S, Liu R, Tchekmedyian S, Tomita D, Lillie T et al (2006) Effectiveness of darbepoetin alfa administered every 3 weeks on clinical outcomes in patients with gastrointestinal cancer and chemotherapy-induced anemia. Poster presented at the ASCO Gastrointestinal Cancers Symposium, San Francisco, CA; Abstract 382
35.
Brilhante D, Macedo A, Santos A (2008) Estimating the microcosts of blood transfusion for hemato-oncological patients. Acta Med Port 21:575–580PubMed
36.
Darba J, Restovic G, Arocho R (2009) Blood transfusion costs in Spain. Review of the literature 2002–2007. PharmacoEconomics Span Res Art 6:44–54
37.
Hadjianastassiou VG, Virich G, Lennox IA (2002) Use of the blood transfusion service in total knee replacement arthroplasty. The cost implications. Knee 9:145–148PubMedCrossRef
38.
Kanavos P, Yfantopoulos J, Vandoros C, Politis C (2006) The economics of blood: gift of life or a commodity? Int J Technol Assess Health Care 22:338–343PubMedCrossRef
39.
Norum J, Moen MA (2008) Practice and costs of red blood cell (RBC) transfusion in an oncological unit. Anticancer Res 28:459–464PubMed
40.
Varney SJ, Guest JF (2003) The annual cost of blood transfusions in the UK. Transfus Med 13:205–218PubMedCrossRef
41.
Shander A, Hofmann A, Ozawa S, Theusinger OM, Gombotz H, Spahn DR (2010) Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 50:753–765PubMedCrossRef
42.
Demetri GD (2001) Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy. Br J Cancer 84(Suppl 1):31–37PubMedCrossRef
43.
Berger ML, Bingefors K, Hedblom EC, Pashos CL, Torrance GW (2003) Health care cost, quality, and outcomes: ISPOR book of terms. ISPOR, Lawrenceville
44.
Bohlius J, Schmidlin K, Brillant C, Schwarzer G, Trelle S, Seidenfeld J et al (2009) Erythropoietin or darbepoetin for patients with cancer: meta-analysis based on individual patient data. Cochrane Database Syst Rev 3:CD007303PubMed
45.
Bohlius J, Wilson J, Seidenfeld J et al (2006) Erythropoietin or darbepoetin for patients with cancer. Cochrane Database Syst Rev 3:CD003407PubMed
46.
Bennett CL, Silver SM, Djulbegovic B et al (2008) Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA 299:914–924PubMedCrossRef
47.
Tonelli M, Hemmelgarn B, Reiman T et al (2009) Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis. CMAJ 180:E62–E71PubMedCrossRef
48.
Glaspy J, Crawford J, Vansteenkiste J et al (2010) Erythropoiesis-stimulating agents in oncology: a study-level meta-analysis of survival and other safety outcomes. Br J Cancer 102:301–315PubMedCrossRef
49.
Vansteenkiste J, Glaspy J, Henry D et al (2012) Benefits and risks of using erythropoiesis-stimulating agents (ESAs) in lung cancer patients: study-level and patient-level meta-analyses. Lung Cancer 76:478–485PubMedCrossRef
50.
Klarenbach S, Manns B, Reiman T, Reaume MN, Lee H, Lloyd A et al (2010) Economic evaluation of erythropoiesis-stimulating agents for anemia related to cancer. Cancer 116:3224–3232PubMedCrossRef
51.
Borg S, Glenngård AH, Osterborg A, Persson U (2008) The cost-effectiveness of treatment with erythropoietin compared to red blood cell transfusions for patients with chemotherapy induced anaemia: a Markov model. Acta Oncol 47:1009–1017PubMedCrossRef
52.
Borget I, Tilleul P, Baud M, Joly AC, Daguenel A, Chouaid C (2006) Routine once-weekly darbepoetin alfa administration is cost-effective in lung cancer patients with chemotherapy-induced anemia: a Markov analysis. Lung Cancer 51:369–376PubMedCrossRef
53.
Spaepen E, Demarteau N, Van Belle S, Annemans L (2008) Health economic evaluation of treating anemia in cancer patients receiving chemotherapy: a study in Belgian hospitals. Oncologist 13:596–607PubMedCrossRef
54.
Duran A, Spaepen E, Lamotte M, Walter E, Lucioni C, Pinheiro B et al (2011) Cost analysis of anemia treatment with erythropoieses-stimulating agents (ESAs) in patients with cancer receiving chemotherapy: a multi-country approach. Poster presented at ISPOR 16th Annual International Meeting, Baltimore, MD; Abstract PSY10
55.
Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F (1998) Systematic reviews of trials and other studies. Health Technol Assess 2:1–276PubMed
Metadata
Title
Hemoglobin level at initiation of darbepoetin alfa: impact on need for transfusion and associated costs in chemotherapy-induced anemia treatment in Europe
Authors
Melike Deger
Wolfgang Eisterer
Lucie Kutikova
Sam Salek
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 2/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1538-0

Other articles of this Issue 2/2013

Supportive Care in Cancer 2/2013 Go to the issue

Original Article

Nurse-led follow-up care for head and neck cancer patients: a quasi-experimental prospective trial

Original Article

Latent structure and reliability analysis of the measure of body apperception: cross-validation for head and neck cancer Patients

Original Article

Symptom clusters using the Spitzer quality of life index in patients with brain metastases—a reanalysis comparing different statistical methods

Original Article

Symptom clusters and symptom interference of HCC patients undergoing TACE: a cross-sectional study in China

Original Article

Impact of the treatment-free interval on health-related quality of life in patients with multiple myeloma: a UK cross-sectional survey

Original Article

Parental sleep experiences on the pediatric oncology ward
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits