Background: Avoiding unnecessary medical visits related to erythropoiesis-stimulating agent (ESA) treatment represents an important consideration for managed-care organizations. Observational data have reported varying visit patterns for cancer chemotherapy patients receiving epoetin alfa (EPO) and darbepoetin alfa (DARB). Few studies have characterized visit patterns in this population during ESA treatment.

Objective and Purpose: The objective of this analysis was to describe visit patterns and identify the proportion of medical visits made exclusively for ESA treatment in cancer chemotherapy patients.

Methods: Analysis of medical claims between 1/2004–12/2005 using the Integrated Health Care Information Systems national database, representing >35 health plans, was conducted. Patients were ≥18 years old, had a cancer diagnosis, received >1 ESA administration, and concurrent chemotherapy (during or within 14 days of ESA initiation). Medical visits during the ESA treatment duration (time from first to last ESA administration) were categorized into mutually exclusive groups based on procedure codes recorded on the visit day: ESA administration, chemotherapy/radiotherapy administration, physician visit, blood count, WBC growth factor administration and other (hydration, antiemetics/antibiotics, etc).

Results: 3,462 EPO and 2,839 DARB patients were identified representing 107,149 unique visits (EPO 62,785, DARB 44,364). Mean ESA treatment duration was similar between groups (Days: EPO 59.3; DARB 57.6, p=0.212). The proportion of visits were categorized into mutually exclusive service groups, presented below.

Conclusion: Cancer chemotherapy patients receiving ESAs incurred visits for many reasons, but primarily for receiving chemotherapy. Less than 5% of all visits were solely related to ESA administration, regardless of ESA received.

Table

Service GroupEPODARB
Chemotherapy 10.3% 12.2% 
Chemotherapy + ESA 24.9% 27.3% 
Physician visit 11.9% 12.5% 
Physician visit + ESA 13.0% 9.9% 
Blood count 1.1% 2.1% 
Blood count + ESA 10.1% 8.4% 
WBC growth factor 0.3% 0.5% 
WBC growth factor + ESA 5.9% 6.8% 
Other 15.9% 14.8% 
Other and ESA 2.6% 2.6% 
ESA only 4.1% 2.9% 
Total 100% 100% 
Service GroupEPODARB
Chemotherapy 10.3% 12.2% 
Chemotherapy + ESA 24.9% 27.3% 
Physician visit 11.9% 12.5% 
Physician visit + ESA 13.0% 9.9% 
Blood count 1.1% 2.1% 
Blood count + ESA 10.1% 8.4% 
WBC growth factor 0.3% 0.5% 
WBC growth factor + ESA 5.9% 6.8% 
Other 15.9% 14.8% 
Other and ESA 2.6% 2.6% 
ESA only 4.1% 2.9% 
Total 100% 100% 
View Large

Topics:
chemotherapy regimen, erythropoiesis-stimulating agents, managed care programs, growth factor, duration of treatment, antibiotics, antiemetic agents, cancer diagnosis, darbepoetin alfa, edmonton symptom assessment scale

Author notes

Disclosure:Employment: Dr McKenzie and Mr. Bookhart are full-time employees of Ortho Biotech Clinical Affairs, LLC. Consultancy: Mr. Lefebvre, Mr. Laliberté, and Dr. Duh are paid consultants of Ortho Biotech Clinical Affairs, LLC. Ownership Interests:; Dr. McKenzie and Mr. Bookhart own stock in Johnson & Johnson.

2007, The American Society of Hematology
2007
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