Medicare and many commercial insurers have employed reimbursement guidelines that look at hemoglobin or hematocrit thresholds for the use of erythropoeisis-stimulating agents in patients with anemia associated with cancer treatment or chronic disease. These policies do not seem to consider quality-of-life gains that may be associated with the therapy.

Researchers from Bethesda, Maryland, conducted a meta-analysis of trials that evaluated the effect of epoetin alfa on quality of life in patients with cancer, HIV/AIDS, and chronic kidney disease (CKD) and were published between January 1993 and September 2005. They were able to review 18 articles with similar inclusion criteria and endpoints. From these randomized, controlled clinical studies, they tried to correlate rising hemoglobin levels to improvements in quality of life among study participants.

The investigators revealed that statistically significant improvements in hemoglobin levels in patients with cancer receiving epoetin alfa compared with those receiving placebo or standard of care (range of between-group improvements, 1.2 to 1.9 g/dL). In patients with HIV/AIDS or CKD who received epoetin alfa improvements of 2.5–2.9 g/dL, and 2.7 g/dL, respectively) were noted compared with placebo or standard of care.

With regard to quality of life, statistically and clinically significant improvements were seen in fatigue and other measures across chronic conditions. Using a linear analog scale assessment scale for energy, improvements of at least 8 mm (which are considered clinically relevant) were frequently observed. Patients with cancer who received epoetin alfa compared with control groups demonstrated improvements of 0.8 to 19.8 mm, compared with control group patients. In those with HIV/AIDS or CKD, the improvements observed were even greater (range, 23–25 mm and 28 mm, respectively).

The researchers concluded that the treatment of anemia associated with either cancer, HIV/AIDS, or CKD can significantly improve healthrelated quality-of-life scores, particularly fatigue. They believe that this improvement is clinically relevant.

Kimel M, Leidy NK, Mannix S, et al: Does epoetin alfa improve health-related quality of life in chronically ill patients with anemia? Summary of trials of cancer, HIV/AIDS, and chronic kidney disease. Value Health 2008;11:57-75.