Cost-Minimization Analysis of Once-Weekly Versus Thrice-Weekly Epoetin Alfa for Chemotherapy-Related Anemia

BACKGROUND: For individuals with chemotherapy-related anemia, the clinical effectiveness of epoetin alfa (EPO) dosed once weekly ([QW], 40,000 units per dose) has been demonstrated to be indistinguishable from that observed with thrice-weekly dosing ([TIW], 10,000 units per dose). Whether the advantage of less-frequent administration justifies the higher EPO dosage used in the weekly regimen in terms of overall cost of care is unknown. OBJECTIVES: To conduct a cost-minimization analysis comparing QW and TIW EPO dosing from a societal perspective. METHODS: Direct and indirect medical cost data were calculated for a 16-week period for 2 large, prospective, multicenter, community-based studies. Costs measured included EPO, transfusions, laboratory tests, office visits, and opportunity cost of patient time. RESULTS: The average total costs in 2002 (first half) dollars were nearly equivalent across the 2 groups (QW: $9,204; 95% confidence interval [CI], $9,057-$9,350. TIW: $9,265; 95% CI, $9,083-$9,447. P=0.60). QW incurred mean drug acquisition costs that were 23% higher (QW: $6,725; 95% CI, $6,611-$6,838. TIW: $5,474; 95% CI, $5,350-$5,598. Pless than0.001). However, QW patients can avoid the resource use and time cost associated with 2 additional office visits incurred each week (QW: $592 [$583-$600]; TIW: $1,709 [$1,678-$1,740]; Pless than0.001). Transfusion and laboratory test costs were slightly higher in the TIW group (QW: $1,888 [$1,837-$1,940]; TIW: $2,082 [$2,020-$2,144]; Pless than0.001). CONCLUSIONS: Total anemia treatment costs over a 16-week period with EPO QW were similar to those of TIW dosing. In the absence of cost differences between regimens, the noneconomic advantages of less-frequent dosing intervals should make weekly dosing increasingly attractive to patients, clinicians, and payers.