COMPARING THE COST-EFFECTIVENESS OF 3 MCG/KG Q2W DARBEPOETIN ALFA WITH STANDARD DOSE EPOETIN ALFA FOR ANEMIA MANAGEMENT IN CHEMOTHERAPY-TREATED CANCER PATIENTS IN UNITED STATES
Glaspy J1, Tchekmedyian N2, Gupta S3
1University of California-Los Angeles, Los Angeles, CA, USA; 2Pacific Shores Medical Group, Long Beach, CA, USA; 3Amgen, Inc, Thousand Oaks, CA, USA
OBJECTIVES: A recent 12-week phase 2 randomized clinical trial evaluated the hemoglobin (hgb) response rates (% patients with hgb increase ≥2 g/dL from base- line, in the absence of RBC transfusion) of four different dosing schedules of darbepoetin alfa administered every other week (q2w) to anemic patients with solid tumors receiving chemotherapy. A randomized group of epoetin alfa patients (40,000 U/wk; dose escalated to 60,000 U/wk at 6 weeks for inadequate response) was the active control. Recent literature indicates the mean dura- tion of anemia treatment with epoetin alfa for cancer patients on chemotherapy to be 16 to 24 weeks. We designed a 20-week model to evaluate the cost- effectiveness of 3.0 mcg/kg Q2wk of darbepoetin alfa (n = 33) compared to epo (n = 32).
METHODS: Average wholesale prices (AWPs) of the 2 drugs in United States were used as the sole cost driver over the expected 20- week anemia treatment period. Response rates at week 12 were used as the efficacy measures for the two thera- pies.
RESULTS: Mean cumulative 20-week doses per patient for darbepoetin alfa and epoetin alfa were esti- mated to be 2,100 mcg (assuming mean patient weight = 70 kg) and 844,800 U, respectively. Compared to the esti- mated 20-week cost of epoetin alfa therapy, darbepoetin alfa was estimated to be $800 less per patient (For the 12-week trial duration, darbpoetin alfa was about $380 cheaper). The response rates at the end of week 12 were found to be similar (60%, with similar confidence inter- vals) for the 2 therapies. Smaller percent patients (3% versus 7%) required RBC transfusions in darbepoetin alfa group. Cost-effectiveness ratio (cost per % patients with hgb response) was superior for darbepoetin alfa ($17,465 versus $18,812).
CONCLUSIONS: Compared to stan- dard practice epoetin alfa therapy, 3.0 mcg/kg Q2wk dar- bepoetin alfa provides a less expensive and cost-effective alternative to Sotrastaurin treat cancer patients with chemotherapy- induced anemia.