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Treating anaemia: deconstructing healthcare costs

ABSTRACT Treatment options for cancer-related anaemia are mainly erythropoietic protein therapies, with adjunctive iron where necessary, or blood transfusions. Erythropoietic proteins (epoetins) are often perceived to be expensive, while blood may be seen as effectively free. This article challenges these assumptions, and compares the cost-effectiveness of the two treatments. Transfusions are associated with significant costs (including hospital care and safety tests). They are also inconvenient, are associated with several risks, and are becoming more expensive as safety tests become more sophisticated. In addition, the blood supply is increasingly limited. In contrast, costs of epoetin treatment mostly relate to the acquisition costs of the drugs, with the convenience and ease of delivery minimising administration costs. Clinical studies show that treatment of cancer-related anaemia with epoetins is significantly more effective than transfusions in terms of haemoglobin (Hb) response and improvements in quality of life (QoL). Epoetins also do not have the risks that are associated with transfusions. Quality-adjusted life years (QALYs) are sometimes used as endpoints in cost-effectiveness studies in cancer-associated anaemia, but are unsuitable for several reasons relating to applicability to the treatment needs of patients. For cost-effectiveness analyses, it is more appropriate to use endpoints that are clinically relevant to anaemia (e.g. Hb or QoL improvements), rather than QALYs. Using these endpoints, epoetins exhibit significantly greater cost-effectiveness when compared with standard care (transfusions as required) in the treatment of cancer-related anaemia. Epoetins can therefore be recommended as the optimal anaemia treatment, with transfusions being reserved for the emergency setting.