Pharmaco-Economic Impact of Transfusion and Erythropoietin (EPO) Administration for Patients Having Myelodysplastic Syndromes (MDS) in an Hematology Department.

The University Hospital of Montpellier is the major university hospital in Languedoc-Roussillon, a region with 2.4 milions of inhabitants including 23–26% of the population having more than 65 years. This hospital includes 1015 beds and places in medicine, and 809 in surgery. Total cost of the products for transfusion concerning the hospital is 7 7606 121$. For the hematology department (56 beds, with 130–150 transplantations per year), the cost of the transfusion products represents 39.53% of the whole budget. 21.26% of the total expenditure of red blood cell (RBC) transfusion and 70.17% of the total expenditure of platelet transfusion are from this hematology department. The outpatient clinic of the department (12 beds) is the major localization for transfusing patients with MDS, representing around 20% of the activity in this part of the department. The total fee of transfusion products for this outpatient clinic is 798 739 $ with 351 464$ for RBC transfusion, representing 44%, while RBC transfusion represents 28% of the activity for the whole department, with 19.7% of increase between 2003 and 2004. The activity of hematology is linked to 2 other sites for outpatient and hospitalization in the region of Languedoc-Roussillon (including 35+10 additional beds). Similar increase of the transfusion was observed. New system of price list concerning medical activity in hospitals has been established in France, with a transfusion price fixed at 873$. By using this new accounting, transfusion appears to be slightly in deficit for an outpatient clinic in a university hospital such ours, considering the other medical activities, particularly transplantation and ambulatory chemotherapy. In addition, the number of patients with MDS is increasing in the region, according to the increase of elderness and number of treated cancers. From 01/02 to 04/05, we treat new patients having MDS, excluding AREB-t, by EPO, subcutaneously, from 12 000 to 60 000 UI per week. 85 patients entered this study. The response rate was based on an increase of hemoglobin level superior or equal to 1.5g%, or a reduction superior or equal to 30% of the transfusion consumption observed for more than 6 months. 22% of the patients reached one of these criteria, with 35% of the patients having refractory anemia (RA), sideroblastic RA or 5q- RA and only 12% of the patients having AREB. Only 5% of the patients transfused had a benefit of EPO. In some patients, we observed a dose effect of EPO between 10 000 and 40 000 UI, but at a lesser extend between 40 to 60 000 UI per week, and lasting less than 3 months. Mean duration of the effect was 1.6 year, depending the transformation risk. Benefit of EPO was not correlated with the hemoglobin level at the inclusion but to the status of MDS. Whole data concerning the indirect and direct costs will be presented for this cohort.