Routine once-weekly darbepoetin alfa administration is cost-effective in lung cancer patients with chemotherapy-induced anemia: A Markov analysis

SummaryBackgroundDespite the clinical efficacy of recombinant human erythropoietin (RHE) on chemotherapy-induced anemia, most cost-effectiveness studies have given unfavorable results.ObjectiveTo determine the cost of managing anemia in unselected patients receiving chemotherapy for lung cancer, and the efficacy and cost-effectiveness of RHE.MethodWe constructed Markov models of two cohorts of patients who received (n = 94) or did not receive (n = 89) darbepoetin (one weekly injection when the hemoglobin level fell below 11 g/dl), focusing on changes in hemoglobin levels, transfusion requirements, anemia management costs, and the cost-effectiveness ratios of the two management strategies.ResultsThe use of RHE significantly reduced the proportion of patients needing transfusions (from 33.6% to 19.1%, p < 0.05) and the number of red cell units used by transfusion (from 2.97 ± 1.47 to 2.11 ± 0.47, p < 0.01). Markov modeling showed that the RHE strategy significantly increased the mean Hb level (13 ± 0.5 g/dl versus 11.9 ± 1 g/dl, p < 0.001), at the price of an increase in the main cost (respectively, US$ 1732 ± 897 and 996 ± 643; p < 0.01). The cost-effectiveness ratio favored the RHE strategy (7.02 versus 9.04). Sensitivity analysis showed that the RHE strategy remained dominant in most situations.ConclusionRoutine use of RHE appears to be cost-effective in patients receiving chemotherapy for lung cancer.