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Author Interview: Peter L. Quon

United Biosource Corporation, Bethesda, Maryland, USA

Abstract:

Cost-Effectiveness of Treating Chronic Anemia with Epoetin Alfa among Hemodialysis  Patients in the United States

ASN 2011 Abstract: [SA-PO2646]
Christopher S. Hollenbeak, PhD, Sumit Mohan, MD, Greg De lissovoy, PhD, Peter L. Quon, Matthew Gitlin, PharmD, Jill Javier, John J. Isitt, MS, William M. McClellan, MD. Penn State College of Medicine; Columbia University; Amgen Consultant; United BioSource Corp.; Amgen, Inc.; Emory University School of Medicine.

What are the main findings of the study?

Our analysis found that over 5 years, targeting Hb 10 to 11 g/dL versus 9 to 10 g/dL resulted in lower costs and better patient outcomes.  Patients treated to a Hb target of 10 to 11 g/dL saw their hospitalizations reduced by approximately 10% (0.51 per patient) which resulted in hospitalization cost offsets of $15,340 per patient and total cost offsets of $13,149 per patient over 5 years.

We also found that targeting Hb 10 to 11 g/dL resulted in 0.09 more quality-adjusted life years (QALYs) per patient over a 5 year time horizon.

Were any of the findings unexpected?

The three main parameters of our model that have the most influence on results are mortality, utility (weighting of life years to quantify quality of life), and hospitalization.  Based on current information on targeting Hb, we had conservatively assumed that mortality would be equivalent between both target groups and utility would improve in Hb 10 to 11 g/dL.

This directly translated to improved QALYs.  Hospitalization rates also improved in Hb 10 to 11 g/dL, and considering the cost per hospitalization, it was expected that this would offset the increased cost of Epoetin alfa. 

What should clinicians and patients take away from this study?

Epoetin alfa use targeting Hb levels of 10 to 11 g/dL versus 9 to 10 g/dL may result in lower costs and better patient outcomes. 

What recommendations do you have for future studies as a result of your study?

Our analysis used observational studies to inform major drivers of the model were necessary, however we considered randomized clinical trial data where possible for the base case analysis to limit potential bias. 

This highlights the uncertainty in the current understanding of targeting Hb levels 10 to 11 g/dL and 9 to 10 g/dL which creates challenges in policy making.  Future research should evaluate the real world costs of targeting Hb targets 10 to 11 g/dL versus 9 to 10 g/dL. 

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