Dose conversion and cost effectiveness of erythropoietic therapies in chemotherapy-related anemia: a Canadian application.

OBJECTIVE

To determine the dose-conversion ratio (DCR) between epoetin alfa and darb-epoetin alfa in cancer patients and compare the treatment costs of both agents at the estimated DCRs.

METHODS

A comprehensive search of the literature was carried out on clinical trials evaluating patients with chemotherapy-related anemia treated with epoetin alfa or darbepoetin alfa. A multivariate meta-analysis regression was conducted to determine the relative doses of these two agents at which they were equally effective. The effectiveness measure used was the area under the hemoglobin change curve. Using the estimated DCR for each dosing regimen, the relative cost of epoetin alfa and darbepoetin alfa treatments in Canada was evaluated.

RESULTS

Twenty-nine study arms, evaluating 12,923 patients (10,582 treated with epoetin alfa and 2341 treated with darbepoetin alfa), were eligible for this study. Results comparing specific dosing regimens indicated that the DCRs were systematically lower than 200:1. The cost premium associated with darbepoetin alfa weekly drug cost was between 37 and 44% above epoetin alfa for the same level of effectiveness.

CONCLUSION

Based on the evidence from this meta-analysis, epoetin alfa appeared to be more cost-effective compared to darbepoetin alfa in Canada for cancer patients.