Utilization and cost comparison of erythropoiesis-stimulating agents in inpatient and outpatient hospital settings

Abstract

Objective:

To compare utilization and associated costs of epoetin alfa (EPO) and darbepoetin alfa (DARB), two erythropoiesis-stimulating agents (ESAs), in patients with cancer undergoing chemotherapy and patients with chronic kidney disease (CKD) not on dialysis in inpatient and outpatient hospital settings.

Methods:

An analysis of medical claims recorded between January 2006 and December 2009 was conducted using the Premier Perspective Comparative Hospital database. Patients included were ≥18 years old with cancer and chemotherapy or with pre-dialysis CKD and with ≥1 claim for EPO or DARB during a hospital inpatient or outpatient treatment episode. Patients treated with both ESAs or who were receiving dialysis were excluded. Mean cumulative drug costs and dose ratios (units EPO: mcg DARB) were calculated using cumulative dose and April 2010 wholesale acquisition costs.

Results:

Cancer chemotherapy: 13,832 inpatient stays (EPO: 10,454; DARB: 3378) and 5590 outpatient treatment episodes (EPO: 2856; DARB: 2734) were identified. The inpatient and outpatient populations reported ESA dose ratios of 230:1 and 238:1 with DARB cost premiums of 42% (EPO: $948; DARB: $1348) and 38% (EPO: $3358; DARB: $4627), respectively. CKD: 148,746 hospital stays (EPO: 116,017; DARB: 32,729) and 11,012 outpatient treatment episodes (EPO: 6921; DARB 4091) were identified. The inpatient and outpatient populations reported ESA dose ratios of 251:1 and 257:1 with DARB cost premiums of 30% (EPO: $566; DARB: $738) and 27% (EPO: $2077; DARB: $2642), respectively.

Limitations:

The lack of randomization may have led to confounding by indication. In addition, statistical significance must be interpreted with caution in studies involving large samples.

Conclusions:

This study of 19,422 patients with cancer receiving chemotherapy and 159,758 patients with pre-dialysis CKD reported ESA dose ratios ranging from 230:1–257:1 (units EPO: mcg DARB) and associated cost premiums of 27–42% for DARB.

Keywords::

• Anemia
• Epoetin alfa
• Darbepoetin alfa
• Dose ratio
• Treatment costs
• Chemotherapy-induced anemia
• Chronic kidney disease

Transparency

Declaration of funding

Funding to support preparation of this manuscript was provided by Janssen Scientific Affairs, LLC. All authors were involved in the conceptual development of this study as well as in the interpretation of the results and the manuscript preparation. All authors reviewed and approved the final content of this manuscript.

Declaration of financial/other interest

MHL, FV, and PL have disclosed that they are employees of Groupe d’analyse, Ltée, a company that has received research grants from Janssen Scientific Affairs, LLC. RAB and RSM have disclosed that they are employees of Janssen Scientific Affairs, LLC.