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Journal of Oncology Pharmacy Practice, Vol. 12, No. 3, 165-178 (2006)
DOI: 10.1177/1078155206069925

Dose conversion and cost effectiveness of erythropoietic therapies in chemotherapy-related anemia: a Canadian application

Pierre Cremieux, PhD

Analysis Group, Inc., Boston, MA, USA, Université du Québec à Montréal, Montreal, Québec, Canada

Francis Vekeman, MA

Groupe d’Analyse, Ltée, Montréal, Québec, Canada

Patrick Lefebvre, MA

Groupe d’Analyse, Ltée, Montréal, Québec, Canada

Objective. To determine the dose-conversion ratio (DCR) between epoetin alfa and darbepoetin alfa in cancer patients and compare the treatment costs of both agents at the estimated DCRs.

Methods. A comprehensive search of the literature was carried out on clinical trials evaluating patients with chemotherapy-related anemia treated with epoetin alfa or darbepoetin alfa. A multivariate meta-analysis regression was conducted to determine the relative doses of these two agents at which they were equally effective. The effectiveness measure used was the area under the hemoglobin change curve. Using the estimated DCR for each dosing regimen, therelativecostofepoetinalfa and darbepoetin alfa treatments in Canada was evaluated.

Results. Twenty-nine study arms, evaluating 12 923 patients (10 582 treated with epoetin alfa and 2341 treated with darbepoetin alfa), were eligible for this study. Results comparing specific dosing regimens indicated that the DCRs were systematically lower than 200:1. The cost premium associated with darbepoetin alfa weekly drug cost was between 37 and 44% above epoetin alfa for the same level of effectiveness.

Conclusion. Based on the evidence from this meta-analysis, epoetin alfa appeared to be more cost-effective compared to darbepoetin alfa in Canada for cancer patients.

Key Words: chemotherapy related anemia • epoetin alfa • darbepoetin alfa • cost effectiveness • dose conversion ratio

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