Transfusions increase with nationally driven reimbursement changes of erythropoiesis stimulating agents for chemotherapy-induced anemia

Abstract

The primary goal of reducing the number of transfusions in patients with CIA by administering ESAs cannot be met when clinical practice coincides with the NCD.

Impact of Centers for Medicare & Medicaid Services national coverage determination on erythropoiesis‐stimulating agent and transfusion use in chemotherapy‐treated cancer patients

“…At the time we performed our study, published studies describing the NCD impact on patient care suggested an increase in transfusions among chemotherapy‐treated cancer patients; however, these studies involved single centers or regional groups of clinics. A more recently published study involves oncology centers from around the country, but is not necessarily nationally representative .…”

Trends in Erythropoiesis‐stimulating agent use and blood transfusions for chemotherapy‐induced anemia throughout FDA's risk evaluation and mitigation strategy lifecycle

“…Several studies reported increases in RBC transfusion rates after NCD 8‐11,15,16 while others reported no impact 7,12,14 . Our post hoc analysis comparing transfusion trends among all Medicare FFS beneficiaries suggests that a secular trend unrelated to ESA use, NCD, REMS implementation, or REMS discontinuation was responsible for the observed small changes in transfusion (eFigure S9).…”

“…Prior studies demonstrated that ESA administration to patients with cancer dropped substantially following NCD 7‐15 . Six of nine studies assessing the impact of NCD on red blood cell (RBC) transfusions reported increased transfusion rates 8‐11,15,16 ; three showed no significant changes 7,12,14 . Four studies assessing the impact of the REMS reported decreased use of ESAs after REMS approval and inconsistent RBC transfusion results 9,15,17,18 …”

Racial/ethnic and gender disparities in the use of erythropoiesis-stimulating agents and blood transfusions: cancer management under Medicare’s reimbursement policy

“…Some previous studies have examined the change in the use of ESAs and blood transfusions in cancer patients before and after the implementation of the Medicare reimbursement policy change. [32][33][34][35][36][37] Documented in the literature is a 26%-57% reduction in the use of ESAs after the policy change. [32][33][34][35] Results are mixed regarding the change in the use of blood transfusions.…”