Center of Innovation in Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
Support Care Cancer. 2014 Dec;22(12):3153-63. doi: 10.1007/s00520-014-2296-y. Epub 2014 Jun 10.
Use of erythropoiesis-stimulating agents (ESAs) in US cancer care declined amidst post-marketing evidence of adverse effects and the Food and Drug Administration's (FDA) addition of a "black-box" warning to product labeling in March 2007. Because reduced ESA use may have led to more transfusions or increased anemia-related health care needs, we measured the policy's impact on health care costs of lung and colon cancer patients receiving chemotherapy.
In a retrospective cohort study of 13,630 lung and 3,198 colon cancer patients in the Department of Veterans Affairs (VA) between 2002 and 2008, we calculated anemia treatment (ESA and transfusion), cancer- and non-cancer-related, and total health care costs for the chemotherapy episode of care. We used multivariable regression to examine health care costs and utilization between patients whose chemotherapy was administered before (PRE) or after (POST) March 1, 2007.
ESA costs declined and transfusion costs were similar, resulting in lower overall POST-period anemia treatment costs (lung, $526 lower, P < 0.01; colon, $504 lower, P < 0.01). Other cancer-related health care costs increased, resulting in markedly higher POST-period total health care costs (lung, $4,706 higher, P < 0.01; colon, $11,414 higher, P < 0.01).
Although chemotherapy episode anemia treatment costs declined after the black-box warning, the savings were offset by increases in other cancer-related costs. Those increases were mainly in outpatient services and pharmacy, suggesting that likely drivers include adoption of new high-cost diagnostic approaches and therapeutic modalities. Additional research is needed to determine the effects of anemia management changes on patient outcomes and to more fully understand cost-benefit relationships in cancer treatment.
在美国，由于上市后证据表明存在不良反应，以及食品和药物管理局（FDA）于 2007 年 3 月在产品标签上添加“黑框”警告，促红细胞生成素刺激剂（ESA）的使用减少。由于ESA 的使用减少可能导致更多的输血或增加与贫血相关的医疗需求，我们衡量了该政策对接受化疗的肺癌和结肠癌患者的医疗成本的影响。
在退伍军人事务部（VA）2002 年至 2008 年间的 13630 名肺癌和 3198 名结肠癌患者的回顾性队列研究中，我们计算了化疗期间的贫血治疗（ESA 和输血）、癌症相关和非癌症相关以及总医疗保健费用。我们使用多变量回归来检查化疗前（PRE）或后（POST）于 2007 年 3 月 1 日的患者的医疗保健费用和利用情况。
ESA 成本下降，输血成本相似，导致 POST 期总体贫血治疗成本降低（肺癌，$526 较低，P < 0.01；结肠癌，$504 较低，P < 0.01）。其他癌症相关的医疗保健费用增加，导致 POST 期总医疗保健费用显著增加（肺癌，$4706 较高，P < 0.01；结肠癌，$11414 较高，P < 0.01）。
尽管黑框警告后化疗期间贫血治疗成本下降，但其他癌症相关成本的增加抵消了这些节省。这些增加主要发生在门诊服务和药房，这表明可能的驱动因素包括采用新的高成本诊断方法和治疗方式。需要进一步研究，以确定贫血管理变化对患者结果的影响，并更全面地了解癌症治疗的成本效益关系。
