Observational Study Finds Changes in Medicare Reimbursement for Erythropoiesis-Stimulating Agents Associated With Increased Need for Blood Transfusion
In July 2007, the Centers for Medicare and Medicaid Services (CMS) issued coverage limitations, in the form of a National Coverage Determination (NCD), for the use of ESAs in anemic cancer patients receiving chemotherapy. An ongoing, prospective, observational study [Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (DOSE) registry] is evaluating ESA-treated anemic cancer patients receiving chemotherapy. The present analyses were conducted using data from this study, focused on patients covered by Medicare before and after implementation of the CMS NCD for ESAs.
"We wanted to examine the potential impacts on transfusion patterns and hematologic changes in anemic Medicare patients receiving chemotherapy treated with ESAs before and after implementation of the ESA coverage limitations," said study director Chris L. Pashos, PhD, Vice President, Abt Bio-Pharma Solutions, Inc. "Our analyses found increased transfusion rates and greater blood utilization in anemic Medicare patients receiving chemotherapy and treated with ESAs after implementation of the ESA NCD compared with before implementation of the ESA NCD."
Study Methods and Results
Data from 288 Medicare patients (pre-NCD: 230, post-NCD: 58) from 41 sites included in the DOSE registry were analyzed. Data were categorized into two timeframes based on date of initial ESA administration (pre-NCD: April 2006 through April 2007; post-NCD: October 2007 through May 2008). Baseline characteristics of pre-NCD and post-NCD patients were similar for age, gender, weight and tumor type.
Compared to the pre-NCD patient group, a significantly greater proportion of Medicare patients in the post-NCD group received blood transfusions (post-NCD 32.8 percent vs. pre-NCD 18.3 percent, p= 0.0157), with greater blood utilization per patient (mean units of blood/patient: post-NCD 1.1 vs. pre-NCD 0.5, p= 0.0089). Significantly lower mean Hb levels (g/dL) were reported in the post-NCD group at all time points [Hb level (g/dL): post-NCD vs. pre-NCD: 9.6 vs. 10.6, 9.9. vs. 11.1, 10.4 vs. 11.2, 9.8 vs. 11.1 and 9.7 vs. 11.0 at baseline, Week 4, Week 8, Week 12 and Week 16, respectively]. The post-NCD ESA dosing guideline that impacts ESA utilization for anemic cancer patients receiving chemotherapy is the requirement to discontinue ESA dosing for Hb levels exceeding 10 g/dL. Safety, including thrombovascular events, was not examined in this analysis. An increased relative risk of thrombovascular events has been observed in ESA-treated patients; physicians should use the lowest dose needed to avoid red blood cell transfusion.
About the DOSE Registry
The Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (DOSE) Registry is an ongoing prospective, observational study that aims to characterize ESA dosing patterns, hematologic outcomes, costs and patient-reported outcomes of anemic cancer patients receiving chemotherapy treated in United States (U.S.) oncology clinics. Centocor Ortho Biotech Services, LLC, supported the DOSE registry and this study.
About PROCRIT (Epoetin alfa)
PROCRIT is an ESA used for the treatment of anemia in patients with most types of cancer receiving chemotherapy, with chronic renal failure who are on dialysis and those who are not on dialysis, who are being treated with zidovudine for HIV infection, and to reduce the need for transfusion in anemic patients who are scheduled for elective noncardiac, nonvascular surgery. Depending on the country in which Epoetin alfa is marketed, these indications may differ.
Important Safety Information
WARNINGS: Increased Mortality, Serious Cardiovascular and Thromboembolic Events, and increased risk of tumor progression OR recurrence
Renal failure: Patients experienced greater risks for death and serious cardiovascular events when administered erythropoiesis-stimulating agents (ESAs) to target higher versus lower hemoglobin levels (13.5 vs. 11.3 g/dL; 14 vs. 10 g/dL) in two clinical studies. Individualize dosing to achieve and maintain hemoglobin levels within the range of 10 to 12 g/dL.
Perisurgery: PROCRIT (Epoetin alfa) increased the rate of deep venous thromboses in patients not receiving prophylactic anticoagulation. Consider deep venous thrombosis prophylaxis.
Additional Important Safety Information
Please visit www.procrit.com for the full Prescribing Information, including the Boxed WARNINGS, and for the Medication Guide and Patient Instructions for Use.
About Ortho Biotech Products, L.P.
Ortho Biotech Products, L.P. is a leading biopharmaceutical company devoted to helping improve the lives of patients with cancer and with anemia due to multiple causes, including chronic kidney disease. Since it was founded in 1990, Ortho Biotech and its worldwide affiliates have earned a global reputation for researching, manufacturing and marketing innovative products that enhance patients' health. Located in Bridgewater, N.J., Ortho Biotech is an established market leader in Epoetin alfa therapy for anemia management. The company also markets treatments for recurrent ovarian cancer, rejection of transplanted organs and other serious illnesses. For more information, visit www.orthobiotech.com.
Note: Data in this release correspond to ASH abstract 1301
-- ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers (see WARNINGS: Table 1). -- To decrease these risks, as well as the risk of serious cardio- and thrombovascular events, use the lowest dose needed to avoid red blood cell transfusion. -- Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy. -- ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure. -- Discontinue following the completion of a chemotherapy course.
SOURCE Ortho Biotech Products, L.P.
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