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Recombinant Erythropoietin for Chemotherapy-Related Anaemia

Economic Value and Health-Related Quality-of-Life Assessment Using Direct Utility Elicitation and Discrete Choice Experiment Methods

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Abstract

Objective

To assess both the health-related quality of life (HR-QOL) and the economic value of erythropoietin treatment in chemotherapy-related anaemia using direct utility elicitation and discrete choice experiment (DCE) methods from a societal perspective in the UK.

Methods

The time trade-off (TTO) method was employed to obtain utility values suitable for the calculation of QALYs for no, mild, moderate and severe anaemia. Health-state descriptions were developed using the Functional Assessment of Cancer Therapy — Anaemia (FACT-AN) subscale and the EQ-5D questionnaires, and were validated by clinical experts and patients. In addition, a DCE was implemented to elicit preferences for various anaemia treatment scenarios. The DCE analysis comprised important aspects of treatment identified from a literature review and by consultation with expert clinicians and cancer patients. The DCE included cost as an attribute in order to elicit willingness-to-pay (WTP) values (£, 2004 values). The two methods were applied in the same cross-sectional sample of 110 lay people. Face-to-face interviews were conducted between February and March 2004.

Results

The mean utility scores were 0.86 (standard error [SE] 0.014) for the no-anaemia state, and 0.78 (SE 0.016), 0.61 (SE 0.020) and 0.48 (SE 0.020) for the mild, moderate and severe anaemia states, respectively. The DCE results revealed the following preferences as significant predictors of choice: higher level of relief from fatigue, lower duration of administration, subcutaneous/intravenous administration versus cannula injection, GP versus hospital location, lower risk of infection or allergic reactions and lower cost per month to the patient. Attribute levels were valued higher for recombinant erythropoietin than for blood transfusion; this is reflected in an incremental welfare value of £368 (95% CI 318, 419).

Conclusions:

The results highlight a societal view that the severity of chemotherapy- related anaemia will significantly affect cancer patients’ HR-QOL. The DCE survey shows that the public value favourably the attributes of treatment with recombinant erythropoietin, and indicates a likely patient preference for treatment with recombinant erythropoietin over blood transfusion

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Notes

  1. Based on a dose of 450 IU/kg/week for a person with an average weight of 67kg using a 30 000IU vial of Epoietin beta (Neorecormon® — Roche).[8] The use of trade names is for product identification purposes only and does not imply endorsement.

  2. In state-of-the-world models, multiple alternatives do not exist in each case.

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Acknowledgements

The authors thank Dr Andrew Weaver from the Churchill Hospital, Oxford, England; Dr Derek Cruickshank from the James Cook University Hospital, Middlesbrough, England and the other clinical experts who helped in the design and validation of the health states for the time trade-off method, and attributes and levels for the discrete choice experiment.

This study was sponsored by the Healthcare Management Group, Roche, UK.

DF Ossa, A Briggs and M Sculpher have acted as consultants to Roche, and T Littlewood has acted as a consultant to Roche, Amgen and Ortho Biotech. W Cowell is a current employee of Roche. A Briggs has a minority shareholding in Oxford Outcomes Ltd, UK.

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Authors and Affiliations

  1. Oxford Outcomes Ltd, Oxford, UK

    Diego F. Ossa, Andrew Briggs & Mark Sculpher

  2. Public Health and Health Policy, University of Glasgow, Glasgow, UK

    Andrew Briggs

  3. Health Economics Research Centre, University of Oxford, Oxford, UK

    Emma McIntosh

  4. Healthcare Management Group, Roche, Welwyn Garden City, UK

    Warren Cowell

  5. John Radcliffe Hospital, Oxford, UK

    Tim Littlewood

  6. Centre for Health Economics, University of York, York, UK

    Mark Sculpher

Authors
  1. Diego F. Ossa
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  2. Andrew Briggs
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  3. Emma McIntosh
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  4. Warren Cowell
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  5. Tim Littlewood
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  6. Mark Sculpher
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Correspondence to Diego F. Ossa.

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Ossa, D.F., Briggs, A., McIntosh, E. et al. Recombinant Erythropoietin for Chemotherapy-Related Anaemia. Pharmacoeconomics 25, 223–237 (2007). https://doi.org/10.2165/00019053-200725030-00005

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