Reimbursement and Managed Care News for January 2008

By Stanton R. Mehr
Published: Friday, Jun 25, 2010
Dosing Patterns and Costs of Erythropoesis-Stimulating Agents in Patients With Cancer

A retrospective study of nearly 9,000 patients with cancer receiving epoetin alfa or darbepoetin alfa found that costs and dosing regimens varied considerably among patients, and may point to recommendations for managed care organizations in determining how to address recent controversies in erythropoiesis-stimulating agent (ESA) prescribing.

Aggregate information was collected from a medical claims database, covering erythropoietin use from 2002 to 2006. The investigators, from Ortho Biotech, found that approximately 4,300 patients taking epoetin and 4,500 taking darbepoetin met the criteria for inclusion into the study. Mean patient ages were 56.6 and 56.4 years, respectively. Three-quarters of the patients in both groups were women. The Table indicates the dosing frequencies among the two groups, with the patients receiving darbepoetin being more likely to receive longer dosing frequencies, although the duration of therapy was identical (61 days).

ESA Dosing Frequencies and Utilization


Dosing Frequency




> Q3W

Cumulative Mean





292,035 units





1,099 ug

The mean cost of treatment regimens were $3,656 for patients receiving epoetin and $5,029 for those receiving darbepoetin.

The authors concluded that extended dosing of both ESAs was common in patients receiving cancer chemotherapy, but drug costs between the two were significantly different.

Another study addressed the hot issue of how “followon” or generic-type biologic agents can save money for the health system, particularly ESAs. Researchers from Express Scripts, a pharmacy benefit manager, assumed that if 70% of patients switched to a “biogeneric” version of epoetin alfa (because its patent expired in 2004), $2 billion can be saved in the first year alone. Noting that this is the fourth largest class of biologics (behind autoimmune diseases, multiple sclerosis, and oncologics), Edmond Weisbart, MD, Chief Medical Officer, Medical Affairs, Express Scripts Inc., believes that $71 billion can be saved in just 10 years if only four categories of biotech agents are considered (ESAs, growth hormone, insulins, and interferon beta 1a and 1b).

Barron JJ, Mody SH, McKenzie RS, et al: Drug utilization and associated costs of erythropoiesis-stimulating agents in managed care patients with cancer receiving chemotherapy. Presented at the 2007 educational meeting of the Academy of Managed Care Pharmacy, October 26, 2007, Boston.

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