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Cost-effectiveness analysis favors epoetin alfa to front-loaded regimens of darbepoetin alfa and dominates every other week dosing of darbepoetin alfa



Cost-effectiveness analysis favors epoetin alfa to front-loaded regimens of darbepoetin alfa and dominates every other week dosing of darbepoetin alfa



Blood 102(11): 511b



Objective: Front-loaded dosing regimens of darbepoetin alfa (DARB) in select patient groups (Glaspy, Cancer 2003, Hesketh ASCO 2003) show a spectrum of clinical benefits similar to standard epoetin alfa (EPO) dosing (Gabrilove, J Clin Oncol 2001, Shasha, Cancer 2003), however, it is unknown whether these DARB regimens or an every other week (Q2W) schedule demonstrate comparable cost-effectiveness (CE). Methods: This 16-week economic model uses data drawn from four large published clinical trials (EPO 1: Gabrilove J Clin Onc 2001; EPO 2: Shasha Cancer 2003, DARB 1: Vadhan-Raj J Support Oncol 2003; DARB 2 and DARB 3: Hesketh ASCO 2003) and compares a fixed dose of EPO (EPO1 and EPO2: 40,000U once-weekly (QW), escalation permitted after 4 weeks to 60,000U QW) to one weight-based dose of DARB (DARB 1: 3 mcg/kg Q2W, escalation permitted after 6 weeks to 5 mcg/kg Q2W) and two front-loaded regimens of DARB (DARB2: 4.5 mcg/kg QW until hemoglobin (Hb) 12.0 g/dL achieved, then 4.5 mcg/kg every three weeks (Q3W); DARB3: 325 mcg QW until Hb 12.0 g/dL then 325 mcg/kg Q3W). Analytic methods are matched for comparison. Clinical benefit is assessed by area under the Hb change curve (AUC). CE is defined as total drug costs (average wholesale price, Red Book 2003) per Hb AUC (g/dL). Results: Initial costs for all DARB regimens are a premium compared to EPO. Compared to EPO, mean weekly and total treatment costs for all DARB regimens range from 12-63% higher. Clinical benefits are similar for DARB front-loaded regimens (DARB 2, DARB 3) but lower for DARB Q2W (DARB 1) dosing compared to EPO. EPO CE ratios are superior to DARB. A marginal gain over EPO in Hb AUC of 0.6 g/dL observed with DARB front-loaded dosing (DARB3) would cost an additional dollar sign5,699.35. Conclusion: In this model, EPO is the most CE alternative compared to front-loading DARB regimens and dominates DARB Q2W dosing.

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