Trends In Transfusion Incidence Among Cancer Patients Receiving Chemotherapy (2005-2008)

e19506 Background: Erythropoiesis-stimulating agents (ESAs) are indicated for anemia due to concomitantly administered chemotherapy to reduce the incidence of red blood cell transfusions. Since 2007, ESA use has been increasingly restricted in product labels, reimbursement, and practice guidelines. We described transfusion incidence from 2005 to 2008 to assess the impact of recent ESA restrictions. Methods: This was a retrospective analysis of the INGENIX database. Episodes of chemotherapy care in cancer patients (EOCCs) from 2005 to Q3 2008 were identified by a gap in chemotherapy of ≥90 days. Proportion of EOCCs with ESAs and transfusions were reported. Due to varying EOCCs durations, we also present transfusion incidence per 100 person-months after adjusting for time at risk. Main analyses included EOCCs with ESAs starting in 2005-2007. Sensitivity analysis included EOCCs with ESAs censored at Q3 of EOCC start year in 2005-2008. Log rank trend tests for ordered groups were conducted for both analyses. Results: From 2005 to 2008, 52,194 EOCCs among 45,974 patients were observed. The proportion of EOCCs with ESAs decreased but the proportion with transfusions increased. Due to data truncation and practice pattern changes, observed average EOCC duration decreased in main analyses. Transfusion incidence per 100 person-months in EOCCs with ESAs increased significantly in both analyses (Table). Conclusions: We found that transfusion incidence among commercially insured cancer patients receiving chemotherapy and ESA increased significantly since recent restrictions on ESA use. As a number of factors could affect calculated transfusion incidence, methods adjusting for EOCC duration may better reflect the impact of practice changes. Transfusion incidence in EOCCs with ESA use EOCCs with ESA EOCCs with ESA censored at Q3 With transfusions With transfusions Year n (%) EOCC Mean (SD) EOCC duration (day) %EOCC Per 100 person-months n (%)EOCC Mean (SD) EOCC duration (day) % EOCC Per 100person-months 2005 7,102 (46) 289 (218) 11 1.2 4,988 (40) 144 (73) 9 1.9 2006 6,411 (45) 308 (185) 11 1.1 3,911 (39) 127 (72) 8 1.8 2007 5,434 (37) 283 (120) 13 1.6 3,481 (32) 139 (70) 10 1.9 2008 2,209 (25) 179 (48) 18 3.3 p value <0.01 <0.01 <0.01 <0.01 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen Amgen I3 Innovus