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Apgar E, Burton TM, Larholt K, Pashos CL, Henry DH, Langholff W, Ellis L, McKenzie RS, Senbetta M, Piech CT. Pre-transfusion hemoglobin (PT-Hb) levels in erythropoiesis-stimulating agent (ESA)-treated patients with chemotherapy-induced anemia (CIA): Results from randomized controlled trial (RCT) and observational data. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mueller CS, Chastek B, Newcomer LN, Senbetta M, McKenzie RS, Piech CT. Impact of erythropoiesis-stimulating agent (ESA) reimbursement policy change on transfusion frequency for patients with chemotherapy-induced anemia (CIA). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Burton T, Larholt K, Pashos CL, Peake C, Bookhart BK, Corral M, Piech CT, McKenzie RS. Transfusion outcomes among oncology patients initiated with erythropoiesis-stimulating agents (ESAs) at baseline (BL) hemoglobin (Hb) of <10 versus 10–11g/dL: Observational data from the dosing and outcomes study of erythropoiesis-stimulating therapies (DOSE) registry. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Larholt K, Burton T, Hoaglin D, Pashos CL, Bookhart BK, Corral M, Piech CT, McKenzie RS. Transfusion outcomes in erythropoiesis-stimulating agent (ESA)-treated cancer chemotherapy patients based on achieved hemoglobin (Hb) levels. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Memisoglu A, Peake C, Buscaino E, McKenzie RS, Forlenza JB, Piech CT. Dosing and Outcomes Study of Erythropoiesis-Stimulating Therapies (D.O.S.E.) Registry: Analysis of outcomes and costs of epoetin alfa (EPO) and darbepoetin alfa (DARB) treatment in cancer patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16009 Background: NCCN anemia treatment guidelines recommend hemoglobin (Hb) levels be maintained between 11 and12 g/dL. To understand erythropoiesis-stimulating therapy (EST) dosing, outcomes and costs in cancer patients, data were analyzed from an ongoing prospective, observational registry (D.O.S.E. Registry) collecting real-world data on cancer patients treated for anemia in U.S. oncology clinics. Methods: Data were collected from participating hospital- and community-based outpatient oncology practices between 1/2004 and 11/2005. This analysis included adult patients who had received ≥2 doses of either EPO or DARB. Outcomes assessed included Hb values at weeks 4, 8, 12, and 16 following EST initiation. Drug cost was based on EST utilization and 2005 wholesale acquisition cost. Results: 652 patients (235 EPO, 417 DARB) from 32 sites were identified. Baseline characteristics of age, gender, Hb, tumor type and ferritin level were similar between treatment groups. The proportion of patients with iron supplementation at baseline was significantly higher in the DARB-treated group (EPO 18% v. DARB 31%, p < 0.001). EPO-treated patients were maintained between 11 and 12 g/dL throughout the therapeutic duration ( Table ). Mean cumulative administered dose of EPO was 393,047 Units and DARB 1205 mcg, corresponding to an overall drug cost of $4,783 for EPO and $5253 for DARB (p = 0.001). Conclusions: These results demonstrate that EPO-treated patients maintained target Hb levels consistent with NCCN guidelines, which was not observed in the DARB-treated patients. Drug cost was significantly higher in the DARB group compared to the EPO group without considering the costs of iron supplementation. [Table: see text] [Table: see text]
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Affiliation(s)
- A. Memisoglu
- Abt Associates, Lexington, MA; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ
| | - C. Peake
- Abt Associates, Lexington, MA; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ
| | - E. Buscaino
- Abt Associates, Lexington, MA; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ
| | - R. S. McKenzie
- Abt Associates, Lexington, MA; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ
| | - J. B. Forlenza
- Abt Associates, Lexington, MA; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ
| | - C. T. Piech
- Abt Associates, Lexington, MA; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ
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Vekeman F, McKenzie RS, Watson S, Mody S, Lefebvre P, Piech CT, Duh MS. Comparison of red blood cell transfusion rates of epoetin alfa and darbepoetin alfa in an inpatient oncology setting. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16002 Background: Epoetin alfa (EPO) and darbepoetin alfa (DARB) are used to treat cancer-related anemia and to reduce the requirements for blood transfusions. To date, limited information on the relative effectiveness of these agents in the inpatient setting is available. This analysis evaluated red blood cell (RBC) transfusion rates in cancer patients receiving EPO or DARB during hospitalization. Methods: An analysis of electronic inpatient hospital records from the Premier Perspective Comparative Hospital Database was conducted to compare RBC transfusion rates in cancer patients receiving EPO or DARB therapy. Study subjects were identified through hospitalizations recorded between 07/2002 and 03/2005 from over 500 hospitals nationwide. Patients were required to be ≥18 years old, have a primary admitting diagnosis of cancer and be treated with EPO or DARB during hospitalization. Patients who had received renal dialysis were excluded. To minimize effects of outliers, 5% of patients with extreme doses in each group were excluded from the dosing analysis. In addition to descriptive statistics on transfusion requirements, a multivariate logistic model was employed to isolate the effect of an individual erythropoietic agent on the risk of RBC transfusion after controlling for patient demographics, comorbidities, admission characteristics, use of IV or oral iron and hospitalization severity markers. Results: Among the 24,814 EPO and 2,990 DARB study patients, mean age and gender distribution at admission were similar (age: EPO 65.3 years, DARB 64.5 years; %women: EPO 53%, DARB 55%). Mean cumulative dose per inpatient stay was EPO 61,656 ± 50,274 Units and DARB 259 ± 340 mcg. RBC transfusions occurred in 37.9% of EPO patients compared to 39.8% of DARB patients (p=0.0404). Transfused EPO patients received a mean of 2.24 units versus 2.20 units for DARB patients (p=0.2111). After adjusting for covariates, the multivariate model confirmed that DARB treatment was associated with a higher risk of transfusion compared to EPO (odds ratio: 1.2, 95% CI: 1.1–1.3, p=0.0007). Conclusions: This analysis of inpatients with cancer indicates DARB treatment is associated with a higher risk of receiving RBC transfusion compared to treatment with EPO. [Table: see text]
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Affiliation(s)
- F. Vekeman
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
| | - R. S. McKenzie
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
| | - S. Watson
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
| | - S. Mody
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
| | - P. Lefebvre
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
| | - C. T. Piech
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
| | - M. S. Duh
- Groupe d’Analyse, Montréal, PQ, Canada; Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Analysis Group, Inc., Boston, MA
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Bolge S, Fastenau J, Howell J, Piech CT, Donohue J. Final results from a choice based conjoint study assessing patient preferences for selected features of erythropoietic agents. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Bolge
- Consumer Health Sciences, Princeton, NJ; Ortho Biotech Clin Affairs, LLC, Bridgewater, NJ
| | - J. Fastenau
- Consumer Health Sciences, Princeton, NJ; Ortho Biotech Clin Affairs, LLC, Bridgewater, NJ
| | - J. Howell
- Consumer Health Sciences, Princeton, NJ; Ortho Biotech Clin Affairs, LLC, Bridgewater, NJ
| | - C. T. Piech
- Consumer Health Sciences, Princeton, NJ; Ortho Biotech Clin Affairs, LLC, Bridgewater, NJ
| | - J. Donohue
- Consumer Health Sciences, Princeton, NJ; Ortho Biotech Clin Affairs, LLC, Bridgewater, NJ
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Hussein MA, Wildgust M, Fastenau J, Piech CT. Cost effectiveness of DVd vs VAd in newly diagnosed multiple myeloma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. A. Hussein
- Cleveland Clinic Foundation, Cleveland, OH; Ortho Biotech Products, L.P., Bridgewater, NJ
| | - M. Wildgust
- Cleveland Clinic Foundation, Cleveland, OH; Ortho Biotech Products, L.P., Bridgewater, NJ
| | - J. Fastenau
- Cleveland Clinic Foundation, Cleveland, OH; Ortho Biotech Products, L.P., Bridgewater, NJ
| | - C. T. Piech
- Cleveland Clinic Foundation, Cleveland, OH; Ortho Biotech Products, L.P., Bridgewater, NJ
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Fastenau J, Lefebvre P, Duh MS, Buteau S, McKenzie RS, Piech CT. Evaluation of the relationship between early hemoglobin rise during epoetin alfa treatment and improved patient-reported quality of life. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Fastenau
- Ortho Biotech Products, L.P., Bridgewater, NJ; Analysis Group Inc., Boston, MA
| | - P. Lefebvre
- Ortho Biotech Products, L.P., Bridgewater, NJ; Analysis Group Inc., Boston, MA
| | - M. S. Duh
- Ortho Biotech Products, L.P., Bridgewater, NJ; Analysis Group Inc., Boston, MA
| | - S. Buteau
- Ortho Biotech Products, L.P., Bridgewater, NJ; Analysis Group Inc., Boston, MA
| | - R. S. McKenzie
- Ortho Biotech Products, L.P., Bridgewater, NJ; Analysis Group Inc., Boston, MA
| | - C. T. Piech
- Ortho Biotech Products, L.P., Bridgewater, NJ; Analysis Group Inc., Boston, MA
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McKenzie RS, Lefebvre P, Rosberg J, Duh MS, Fastenau J, Piech CT. Comparison of anemia outcomes associated with early response to epoetin alfa (EPO) withQW and TIW dosing. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. S. McKenzie
- Ortho Biotech Products, L.P., Dallas, TX; Analysis Group Inc., Boston, MA
| | - P. Lefebvre
- Ortho Biotech Products, L.P., Dallas, TX; Analysis Group Inc., Boston, MA
| | - J. Rosberg
- Ortho Biotech Products, L.P., Dallas, TX; Analysis Group Inc., Boston, MA
| | - M. S. Duh
- Ortho Biotech Products, L.P., Dallas, TX; Analysis Group Inc., Boston, MA
| | - J. Fastenau
- Ortho Biotech Products, L.P., Dallas, TX; Analysis Group Inc., Boston, MA
| | - C. T. Piech
- Ortho Biotech Products, L.P., Dallas, TX; Analysis Group Inc., Boston, MA
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Abstract
An evaluation of treatment practices in 13 countries, not including the United States, has shown oral terbinafine to be more cost-effective (from a government payer perspective) than griseofulvin, itraconazole, and ketoconazole in the treatment of onychomycosis of toenails and fingernails. The purpose of this study was to evaluate the clinical and economic effects of oral griseofulvin, itraconazole, ketoconazole, and terbinafine in the treatment of onychomycosis from the perspective of a third-party payer in the United States. A previously constructed decision-analytic model evaluating the costs of onychomycosis in 13 countries outside the United States was updated to determine the costs of treating onychomycosis in the United States. Clinical management patterns were assessed to identify and quantify physician visits, laboratory tests, and adverse drug reaction treatment components for patients with toenail and fingernail onychomycosis. A random-effects model meta-analysis of treatment efficacy (mycologic cure) and New York Metropolitan Medicare charge data for physician fees were used in the treatment model. A sensitivity analysis assessing alternative dosing regimens and a rank order stability analysis investigating the effects of length of treatment, success rates, relapse rates, and drug acquisition costs on overall results were also conducted. Terbinafine had the lowest cost per mycologic cure after one treatment regimen for onychomycosis in both toenail and fingernail infections ($791.00 and $454.00, respectively). The costs of treating toenail and fingernail infections were comparatively higher for therapy with itraconazole ($1535.00 and $767.00, respectively), griseofulvin ($2385.00 and $837.00, respectively), and ketoconazole ($10,025.00 and $1512.00, respectively). As a primary treatment choice, terbinafine also had the lowest overall expected cost per patient for both toenail and fingernail infections ($977.00 and $550.00, respectively). Griseofulvin had expected costs ($1543.00 and $822.00, respectively) similar to itraconazole ($1588.00 and $894.00, respectively), whereas ketoconazole was the most expensive primary treatment choice ($2359.00 and $1287.00, respectively). This study demonstrates that terbinafine is an economical and cost-effective treatment for patients with dermatophytic onychomycosis, supporting European and Canadian studies. Except for the rank order of griseofulvin and itraconazole, sensitivity analyses show that these results are fairly stable.
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Affiliation(s)
- A Marchetti
- Sandoz Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Wiener J, Penner R, Kraus I, Latimer B, Jones D, Moeller D, Tyler SF, Trout M, Piech CT. Recession. What's ahead for hospitals? Interview by John Herrmann and Jennifer L. Smith. Health Syst Rev 1991; 24:20-7. [PMID: 10110609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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