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e17524 Background: With recent changes in erythropoiesis-stimulating agent (ESA) labeling and coverage limitations by the Centers for Medicare and Medicaid Services, it is important to examine the evolution of EPO and DARB real-world utilization in cancer patients receiving chemotherapy in a hospital outpatient setting. Methods: Electronic outpatient records (2006–2007) from >500 hospitals in the Premier Perspective Comparative Hospital Database were analyzed. Subjects were ≥18 years, had ≥1 cancer diagnosis, received chemo during newly initiated ESA therapy, and ≥2 doses during the treatment episode (classified by quarter of ESA initiation). Mean cumulative dose and dose ratio of EPO:DARB were calculated. 2% of patients with extreme doses were excluded. Results: 7,259 outpatient treatment episodes were identified (EPO 3,568;DARB 3,691). EPO patients were slightly younger (years; EPO 62.7;DARB 64.0, p [Table: see text] [Table: see text]

9624 Background: Pegfilgrastim is a long-acting granulocyte colony-stimulating factor (G-CSF) used to prevent or treat febrile neutropenia associated with myelosuppressive anticancer therapies. According to the prescribing information, pegfilgrastim should not be administered within 14 days before or 24 hours after cytotoxic chemotherapy because of the potential for myeloid toxicity. This study examined use patterns of pegfilgrastim in real-life practice. Methods: Analysis of health insurance claims data in 2000- 2007 from > 35 large health plans across the US was conducted. Patients who had a cancer diagnosis and chemotherapy within 120 days of their first pegfilgrastim injection were identified. The proportion of pegfilgrastim injections that were followed by administration of chemotherapy within 11 and 9 days was calculated. Analysis was also stratified by cancer type [Non-Hodgkin's lymphoma (NHL), lung, breast]. Results: A total of 13,526 cancer patients received 57,118 pegfilgrastim injections. NHL, lung, and breast cohorts comprised 2,722, 2,772, and 4,955 patients, respectively. Mean age (SD) was 55.0 (11.6) and women represented 65.9% of study population. Among all cancer types, 19.2% of pegfilgrastim injections had a chemotherapy claim within the following 11 days. This pattern of use was the highest in NHL (18.9%), followed by lung (17.1%), and breast (16.2%). Similar results were observed in the 9-day sensitivity analysis (see Table ). Conclusions: Based on the retrospective analysis of this administrative claims database, the use of pegfilgrastim within 11 days of an administration of chemotherapy was observed in 15–20% of cases which is inconsistent with the recommended guidelines. Pegfilgrastim use in these situations may have the potential to increase sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy. Further research is being conducted to assess the related clinical and economic impact of this pattern of usage. [Table: see text] [Table: see text]

Background: Prevalent in the majority of patients at diagnosis, anemia associated with myelodysplastic syndromes (MDS) may increase in incidence and severity during the course of the disease. Red blood cell (RBC) transfusion support is often used to manage symptomatic anemia. Epoetin alfa (EPO) and darbepoetin alfa (DARB), two erythropoiesis-stimulating agents (ESAs), are frequently used as supportive care in the treatment of MDS-related anemia to reduce RBC transfusions. To date, limited information on dosing patterns and the associated costs of these agents for MDS patients in the hospital inpatient setting is available. This study examined cumulative ESA dosing and costs in MDS patients treated with ESAs in acute care hospitals. Methods: An analysis of electronic inpatient records from the Premier Perspective Comparative Hospital Database was conducted. The Premier database encompasses detailed inpatient services from patients admitted to more than 500 hospitals nationwide. A retrospective parallel-group design was used to compare two cohorts of MDS patients treated with EPO or DARB during their hospitalization. Study subjects were identified through hospitalization records between 4Q2006 and 1Q2008. Patients were ≥18 years of age, had an admitting diagnosis of MDS (ICD-9 codes: 238.72–238.75), and were treated with EPO or DARB during their hospital stay. Patients were excluded if they had cancer, received renal dialysis, or were treated with both ESAs. To minimize effect of outliers, 2% of patients, based on the upper and lower 1% patients with extreme doses in each group were excluded from the dosing analysis. Mean cumulative dose and July 2008 wholesale acquisition costs (EPO: $13.13/1,000 Units, DARB: $4.722/mcg) were used to calculate ESA costs. Results: A total of 3,312 inpatient stays were identified with a primary or secondary diagnosis of MDS (EPO: 2,719, DARB: 593). Mean age and gender distribution were comparable between groups (age: EPO 77.5 years, DARB 78.0 years; % women: EPO 49.4%, DARB 49.2%, p>.05 for both). Mean hospitalization length of stay was also similar for both groups (EPO: 8.8 days; DARB: 8.9 days; p>.05). The two groups were also comparable in terms of medical history at baseline, including hypertension, diabetes mellitus, cardiovascular disease, congestive heart failure, febrile neutropenia, chronic kidney disease, and sepsis. The mean cumulative dose per inpatient stay was 59,379 ± 66,002 Units for EPO and 230 ± 239 mcg for DARB, corresponding to a dose ratio of 258:1 (Units EPO: mcg DARB). Mean cumulative dose of EPO and DARB remained relatively stable over the period from 4Q2006 to 1Q2008. ESA treatment cost per inpatient stay was significantly lower in the EPO group, compared with DARB (EPO $780 vs. DARB $1,085; P Conclusions: The current study, based on recent real-life clinical practice data from an inpatient setting, observed a dose ratio of 258:1 (Units EPO: mcg DARB) in patients with MDS. Based on the cumulative dose administered during hospitalization, EPO was associated with a cost savings of 28% compared to DARB. These results are similar to those observed in MDS patients in the outpatient setting and consistent with reported findings in the chronic kidney disease and oncology populations both in outpatient and inpatient settings.