ESA prescriptions down, transfusions up since Medicare reimbursement restriction introduced

Hess G. Am J Hematol. 2010;doi:10.1002/ajh.21837.

Physicians have reduced the total number of prescriptions for erythropoiesis-stimulating agents issued to patients with chemotherapy-induced anemia since the Centers for Medicaid and Medicare Services restricted reimbursement, according to results from an observational study.

The CMS in June 2007 issued a national coverage decision that said physicians would be reimbursed for assigning ESAs only when the agents were administered to patients with hemoglobin levels of less than 10 g/dL at the start of therapy.

Researchers reviewed data on 4,784 patients collected in the pre-decision era from June 2006 to March 2007 and 5,605 patients collected in the post-decision era from June 2007 to March 2008. The percentage of patients who received myelosuppressive chemotherapy in the pre-decision era (29.3%) was roughly equal to the post-decision era (28.5%; P=.36).

However, the percentage of patients assigned to ESAs decreased significantly from 41.3% in the pre-decision era to 30.4% in the post-decision era, a relative decline of 26%.

There was a 17% increase in the percentage of patients undergoing blood transfusions between the two eras, from 7.6% to 8.9% (P=.015).

The move away from ESAs and toward transfusion was most evident in patients aged 65 years or older; ESA use decreased 29% between the two eras in this cohort (46% vs. 32.6%). The rate of blood transfusions increased 31% compared with the pre-decision era, from 6.7% to 8.8%.

Among younger patients, the rate of ESA assignments decreased by 24%, but the rate of blood transfusions only increased by 8%, a rate the researchers determined was not significant.

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