TY - JOUR
T1 - Predicted costs of iron-chelators in myelodysplastic syndromes
T2 - A 10-year analysis based on actual prevalence and red cell transfusion rates
AU - Durairaj, Senthilkumar
AU - Chew, Stephen
AU - Hyslop, Ann
AU - Keenan, Norene
AU - Groves, Michael J.
AU - Tauro, Sudhir
PY - 2011/5
Y1 - 2011/5
N2 - Consideration of iron-chelation (IC) in transfusion-dependent patients is recommended in most clinical-practice guidelines on myelodysplastic syndromes (MDS). The financial impact of IC on health-care systems is predicted through economic modeling, but an analysis based on actual prevalence is lacking. Here, we have investigated the potential drug-costs and need for IC in a cohort of 189 United Kingdom-based MDS patients diagnosed from 2000 to 2010. Patients with low or intermediate-1 IPSS scores were identified as eligible for IC if >= 24 red cell units (RCU) had been transfused over 12 consecutive months or the transfusion-intensity averaged >= 2 RCU per month. Drug-costs were calculated from the time patients qualified for IC until death or last follow-up. In 159 patients with low/intermediate-1 MDS, survival was superior with a low IPSS score (P = 0.014), age <70 years (P = 0.043), transfusion-independence at diagnosis (P = 0.0056) and transfusion-intensity of <2 RCU per month (P = 0.009). Reflecting the time elapsed since diagnosis, longer survival was observed with a cumulative red cell load of >= 75 U (P = 0.046). By logistic-regression analysis, transfusion-intensity independently predicted survival (P = 0.0035) in low and intermediate-1 risk MDS patients. Forty-one patients fulfilled criteria for consideration of IC. Of these, 6 patients died within 1 month; 35 patients survived for a median of 16 months (range 1-61). Had patients commenced IC, the anticipated drug-costs alone would have been similar to$526,880-$2,064,800 over 10 years. The lack of association between cumulative transfusion-load and survival calls for a prospective evaluation of the cost-utility of IC in patients surviving long-term, to enable evidence-based recommendations in MDS management. Am. J. Hematol. 86:406-410, 2011. (C) 2011 Wiley-Liss, Inc.
AB - Consideration of iron-chelation (IC) in transfusion-dependent patients is recommended in most clinical-practice guidelines on myelodysplastic syndromes (MDS). The financial impact of IC on health-care systems is predicted through economic modeling, but an analysis based on actual prevalence is lacking. Here, we have investigated the potential drug-costs and need for IC in a cohort of 189 United Kingdom-based MDS patients diagnosed from 2000 to 2010. Patients with low or intermediate-1 IPSS scores were identified as eligible for IC if >= 24 red cell units (RCU) had been transfused over 12 consecutive months or the transfusion-intensity averaged >= 2 RCU per month. Drug-costs were calculated from the time patients qualified for IC until death or last follow-up. In 159 patients with low/intermediate-1 MDS, survival was superior with a low IPSS score (P = 0.014), age <70 years (P = 0.043), transfusion-independence at diagnosis (P = 0.0056) and transfusion-intensity of <2 RCU per month (P = 0.009). Reflecting the time elapsed since diagnosis, longer survival was observed with a cumulative red cell load of >= 75 U (P = 0.046). By logistic-regression analysis, transfusion-intensity independently predicted survival (P = 0.0035) in low and intermediate-1 risk MDS patients. Forty-one patients fulfilled criteria for consideration of IC. Of these, 6 patients died within 1 month; 35 patients survived for a median of 16 months (range 1-61). Had patients commenced IC, the anticipated drug-costs alone would have been similar to$526,880-$2,064,800 over 10 years. The lack of association between cumulative transfusion-load and survival calls for a prospective evaluation of the cost-utility of IC in patients surviving long-term, to enable evidence-based recommendations in MDS management. Am. J. Hematol. 86:406-410, 2011. (C) 2011 Wiley-Liss, Inc.
KW - PROGNOSTIC SCORING SYSTEM
KW - LOWER-RISK
KW - SURVIVAL
KW - OVERLOAD
KW - MDS
KW - DEFERASIROX
KW - THERAPY
KW - ANEMIA
U2 - 10.1002/ajh.22001
DO - 10.1002/ajh.22001
M3 - Article
C2 - 21523799
SN - 0361-8609
VL - 86
SP - 406
EP - 410
JO - American Journal of Hematology
JF - American Journal of Hematology
IS - 5
ER -