Killian Aaron D, Gupta Vikas, Goetz Alisa E
Cardinal Health Clinical Research Group, Dallas, TX 75204, USA.
Ann Pharmacother. 2006 Mar;40(3):421-6. doi: 10.1345/aph.1G453. Epub 2006 Feb 28.
Inpatient costs associated with different erythropoietic-stimulating therapy regimens have not been compared in an oncology setting.
To conduct a cost analysis of different regimens of epoetin alfa (EPO) and darbepoetin alfa (DARB) in an inpatient oncology setting.
A retrospective evaluation of oncology diagnosis-related group discharges during 2003, in 30 community hospitals, identified EPO treatment patterns. Wholesale acquisition costs were determined for patients who received EPO 40,000 units or more once weekly. Potential differences in costs were calculated using conversion ratios for an equivalent EPO dose 3 times weekly or DARB dose once weekly (EPO:DARB ratio 260:1, approximating DARB 150 microg once weekly). A sensitivity analysis was performed using an EPO:DARB ratio of 400:1, approximating DARB 100 microg once weekly (1.5 microg/kg).
Among the 1410 EPO doses administered (n = 677 pts.), a dose of 40,000 units or more was used 44% of the time (n = 311 pts.), with dosing initiated on average 5.6 days after admission. For these 311 evaluable patients, switching from EPO 40,000 units once weekly to EPO 10,000 units 3 times weekly reduced per-patient and total drug acquisition costs by approximately 50% (704 US dollars vs 359 US dollars and 218,938 US dollars vs 111,615 US dollars, respectively). Relative to EPO once weekly, switching patients to DARB resulted in increased drug acquisition costs at the 260:1 conversion and lower costs at the 400:1 conversion. However, EPO 3 times weekly remained the least costly option by 44-63%. The cost-savings realized with EPO 10,000 units 3 times weekly increased with longer duration of hospitalization.
In an inpatient setting, use of EPO 10,000 units 3 times weekly may minimize expenditures associated with treatment of cancer-related anemia using erythropoietic-stimulating therapies.
在肿瘤治疗环境中，尚未对不同促红细胞生成治疗方案的住院费用进行比较。
在住院肿瘤治疗环境中，对不同剂量的重组人促红细胞生成素（EPO）和聚乙二醇化重组人促红细胞生成素（DARB）方案进行成本分析。
对2003年30家社区医院的肿瘤诊断相关分组出院病例进行回顾性评估，确定EPO治疗模式。确定每周接受一次40,000单位或以上EPO治疗患者的批发采购成本。使用每周三次等效EPO剂量或每周一次DARB剂量的换算率（EPO:DARB比率为260:1，近似于每周一次150微克DARB）计算成本的潜在差异。使用EPO:DARB比率为400:1（近似于每周一次100微克DARB（1.5微克/千克））进行敏感性分析。
在1410次EPO给药（n = 677例患者）中，44%（n = 311例患者）的时间使用了40,000单位或以上的剂量，给药平均在入院后5.6天开始。对于这311例可评估患者，从每周一次40,000单位EPO改为每周三次10,000单位EPO可使每位患者的药物采购成本和总药物采购成本降低约50%（分别为704美元对359美元和218,938美元对111,615美元）。相对于每周一次EPO，将患者改用DARB在260:1换算时会增加药物采购成本，在400:1换算时成本较低。然而，每周三次EPO仍然是成本最低的选择，节省44 - 63%。每周三次10,000单位EPO实现的成本节省随着住院时间延长而增加。
在住院环境中，每周三次使用10,000单位EPO可能会使使用促红细胞生成疗法治疗癌症相关贫血的相关支出降至最低。
