Cost-effectiveness of treating chronic anemia with epoetin alfa among hemodialysis patients in the United States

OBJECTIVES: The objectives of this analysis were to assess health and economic consequences of targeting hemoglobin (Hb) levels around 10-11 g/dL relative to 9-10 g/dL using an economic model and to explore the impact of different assumptions on cost-effectiveness. STUDYDESIGN: Clinical and economic impact of treating anemia in the US hemodialysis population to target Hb levels of 10-11 g/dL and 9-10 g/dL was assessed using a Markov model. A sensitivity analysis assessed the effects of varying assumptions on the model. RESULTS: Our cost-effectiveness analysis suggests that maintaining Hb 10-11 g/dL would result in average reductions of 0.51 hospitalizations and increases of 0.09 quality-adjusted life years per patient, with hospitalization cost offsets of $15,340 over 5 years when compared with Hb of 9-10 g/dL. Over the lifetime of the patient, cost-effectiveness improved with hospitalization cost offsets of $21,450 and increases of 0.12 quality-adjusted life years. Sensitivity analysis of individual parameters showed that mortality, hospitalization, health preference, and time horizon of the model had the most influence on cost-effectiveness. CONCLUSIONS: Our analysis suggests that epoetin alfa use targeting Hb levels of 10-11 g/dL relative to 9-10 g/dL may result in better patient outcomes and lower costs. The sensitivity analysis highlighted how assumptions affected cost-effectiveness conclusions; the appropriateness of these assumptions will remain uncertain until new research in today's dialysis population examining the effects of targeting to lower Hb levels is conducted.