Spaepen Erik, Demarteau Nadia, Van Belle Simon, Annemans Lieven
IMS Health, Brussels, Belgium.
Oncologist. 2008 May;13(5):596-607. doi: 10.1634/theoncologist.2007-0219.
Erythropoiesis-stimulating agents (ESAs) are used in chemotherapy-induced anemia (CIA) with the goal of improving quality of life and preventing RBC transfusions. This retrospective database study compared the three currently available ESAs, epoetin alfa (EPO-A), epoetin beta (EPO-B), and darbepoetin alfa (DARB), regarding costs and outcomes.
Data were obtained from a Belgian longitudinal database, including medical and financial data on cancer patients receiving chemotherapy and ESAs, submitted by 46 Belgian hospitals. Propensity score matching was applied to correct for selection bias. The main effectiveness parameter was defined as transfusion- and anemia-readmission-free survival (TA-free survival) at 3 months. Costs were analyzed taking the health care payer perspective.
Including 1,584 EPO-A, 380 EPO-B, and 429 DARB propensity-matched patients, TA-free survival rates were similar for the three groups (DARB, 84.37%; EPO-A, 84.60%; EPO-B, 84.94%). Overall inpatient costs were euro 16,949 +/- euro 1,025, euro 19,472 +/- euro 901, and euro 19,295 +/- euro 1,048 for DARB, EPO-A, and EPO-B, respectively (DARB versus EPO-A, p < .0001 and DARB versus EPO-B, p = .008). Anemia-associated costs were euro 3,051 +/- euro 218 in the DARB group, compared with euro 3,995 +/- euro144 for EPO-A (p < .0001) and euro 3,752 +/- euro 229 for EPO-B (p = .0132).
To our knowledge, this is the first real-life matched retrospective study comparing ESAs with regard to both costs and effects. For similar patient profiles, the patients in the DARB group consumed the smallest amounts of ESAs, with similar clinical outcomes. These data therefore suggest a greater efficiency of DARB in the treatment of CIA.
促红细胞生成素（ESAs）用于化疗所致贫血（CIA），目的是改善生活质量并预防红细胞输血。这项回顾性数据库研究比较了目前可用的三种ESAs，即阿法依泊汀（EPO - A）、贝他依泊汀（EPO - B）和达贝泊汀α（DARB）的成本和疗效。
数据取自比利时纵向数据库，包括46家比利时医院提交的接受化疗和ESAs的癌症患者的医疗和财务数据。采用倾向得分匹配法校正选择偏倚。主要有效性参数定义为3个月时无输血和无贫血再入院生存期（无TA生存期）。从医疗保健支付者的角度分析成本。
纳入1584例EPO - A、380例EPO - B和429例DARB倾向得分匹配患者，三组的无TA生存率相似（DARB组为84.37%；EPO - A组为84.60%；EPO - B组为84.94%）。DARB组、EPO - A组和EPO - B组的总体住院成本分别为16,949欧元±1,025欧元、19,472欧元±901欧元和19,295欧元±1,048欧元（DARB组与EPO - A组比较，p <.0001；DARB组与EPO - B组比较，p =.008）。DARB组与贫血相关的成本为3,051欧元±218欧元，EPO - A组为3,995欧元±144欧元（p <.0001），EPO - B组为3,752欧元±229欧元（p =.0132）。
据我们所知，这是第一项比较ESAs成本和疗效的现实生活中匹配的回顾性研究。对于相似的患者情况，DARB组患者使用的ESAs量最少，临床结局相似。因此，这些数据表明DARB在治疗CIA方面效率更高。
