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Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes
Author(s) -
Gawade Prasad L.,
Berlin Jesse A.,
Henry David H.,
Tomita Dianne,
Brooks Barry D.,
Franklin Janet,
Bradbury Brian D.,
Critchlow Cathy W.
Publication year - 2017
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4293
Subject(s) - medicine , erythropoiesis , reimbursement , red blood cell transfusion , cancer , intensive care medicine , blood transfusion , anemia , law , health care , political science
Purpose Evaluate changes in use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in cancer patients receiving myelosuppressive chemotherapy following regulatory and reimbursement actions. Methods Calendar year patient cohorts (2005‐2013) with breast, colorectal, lung, multiple myeloma, non‐Hodgkin lymphoma, ovarian, or prostate cancer and receiving myelosuppressive chemotherapy were identified within the Marketscan database. Incidence of ESA treatment and transfusion were estimated in each year, as was median number of ESA administrations. Clinical characteristics associated with ESA administration and transfusions were evaluated by using multivariable logistic regression. Additionally, annual new ESA user cohorts within the Oncology Services Comprehensive Electronic Records database (2011‐2014) were examined to assess hemoglobin levels at ESA initiation. Results Across all tumor types, ESA use decreased substantially (breast cancer: 53.7 to 3.2%; lung cancer: 66.0 to 13.3%, non‐Hodgkin lymphoma: 39.8 to 3.8%), transfusion use increased (2 to 5.5%, 5.5 to 18.2%, and 4.5 to 9.1%, respectively), and median number of ESA administrations declined. Across all tumor types, proportion of patients initiating an ESA with hemoglobin >10 g/dL was <10% from 2011 onward. In recent years, cancer patients who are older, female, and have chronic kidney disease or moderate or severe liver disease were most likely to receive ESAs. Conclusion Subsequent to important regulatory and reimbursement ESA‐related actions, total ESA exposure among cancer patients receiving myelosuppressive chemotherapy declined substantially. Today, fewer patients receive ESA therapy, and among those treated, more are initiated at hemoglobin levels <10 g/dL and are exposed for a shorter duration, consistent with current product labeling.