ERYTHROPOIESIS STIMULATING AGENTS IN THE TREATMENT OF ANEMIC HEART FAILURE PATIENTS – A COST-UTILITY ANALYSIS

Objectives: Previous studies have suggested that anemia is common in patients with heart failure (HF) and is associated with both impaired quality of life and prognosis. The goal of this study was to assess the economic burden of anemia in HF patients and the potential clinical benefits of treatment with erythropoiesis stimulating agents (ESAs).

 Methods: Design: Cost-utility analysis using a 5-state microsimulation Markov Model. Data sources: Model parameters were based on the studies STAMINA-HFP, SOLVD, EPHESUS, Medicare reimbursement estimates, and published literature. Target population: Patients with HF and a Hb level of 12 g/dl or less. Intervention: Standard care for HF according to AHA/ACC guidelines vs. ESA for twelve months + standard care. Outcome measures: Quality-adjusted life-years gained (QALY), life-years gained (LYG), lifelong medical costs, and incremental cost-utility ratio (ICUR).

 Results: We estimated a life expectancy of 2.38 years or 1.69 QALYs for standard treatment and 2.41 life-years or 1.72 QALYs for standard treatment plus ESA. Costs were estimated to be $7,500 for standard treatment and $8,700 for standard treatment plus ESA.  This resulted in an ICUR of $35,900/QALY (95% credibility interval: $14,000/QALY to infinity). The ICUR is sensitive to the relative treatment benefit and the costs of ESA.

 Conclusions: Based on our model, treatment of anemic CHF patients with ESA appears to be cost-effective when compared with other well-accepted medical interventions. However, these results assume that treatment of anemia in HF patients will produce the clinical benefits predicted by epidemiologic models, and should therefore be verified in RCTs.