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Benefits Associated with an Early Hemoglobin Response to Epoetin Alfa Therapy in the Treatment of Chemotherapy-Related Anemia

Susana M. Campos, Mei Sheng Duh, Patrick Lefebvre, and James Rosberg

Although previous studies have recognized that timely correction of anemia is desirable, no published research quantifies the association between the timeliness of the hemoglobin rise and patients' outcomes. This study evaluates whether anemic patients with cancer who are receiving chemotherapy and who experienced an early response to epoetin alfa (≥ 1 g/dL hemoglobin increase at the end of 4 weeks of treatment) experienced better clinical and drug utilization outcomes compared with patients who did not experience an early response. Three large, open-label, community studies of epoetin alfa for the treatment of chemotherapy-related anemia were retrospectively analyzed to assess the association of early hemoglobin response to subsequent transfusion requirements, subsequent hemoglobin response, quality of life, and epoetin alfa dosage administered over the study. Two epoetin alfa dosing regimens were evaluated: 10,000 units 3 times weekly with potential escalation to 20,000 units, and 40,000 units once weekly with potential escalation to 60,000 units. In all studies, patients who experienced an early hemoglobin response had statistically lower subsequent transfusion requirements, higher rates of subsequent hemoglobin response, shorter time to hemoglobin response, better improvements in quality of life scores, and lower average weekly epoetin alfa dose than patients who did not experience an early hemoglobin response. Similar proportions of patients experienced early response in the 3-times weekly and once-weekly epoetin alfa regimens. This ad hoc analysis found that early hemoglobin response to epoetin alfa therapy was associated with improved clinical benefits and drug utilization. Early hemoglobin response may therefore be considered as a desired goal of epoetin alfa therapies.

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Geographic Variation of Adjuvant Breast Cancer Therapy Initiation in the United States: Lessons From Medicare Part D

John A. Charlson, Emily L. McGinley, Ann B. Nattinger, Joan M. Neuner, and Liliana E. Pezzin

recent studies, however, suggest that drug utilization under Part D has been uneven, with prescription drug use among Part D enrollees varying significantly by geographic regions. 1 , 2 Adjuvant endocrine therapy for breast cancer is a useful model for

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Obstacles to the Implementation of Antiemetic Guidelines

Steven M. Grunberg

effect of a consensus statement on the practice of physicians . N Engl J Med 1989 ; 321 : 1306 – 1311 . 26 Drug Utilization Review Team in Oncology . Antiemetic prescription in Italian breast cancer patients submitted to adjuvant

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New Cancer Drug Approvals From the Perspective of a Universal Healthcare System: Analyses of the Pan-Canadian Oncology Drug Review Recommendations

Saroj Niraula and Zoann Nugent

These factors together increase the potential for inappropriate overuse of costly drugs with marginal benefits. Oversight of drug use, such as by institutional drug formulary committees, can protect against this practice at the final stage of drug