Erythropoietin (EPO) stimulating agents:  impact of proposed cms guidelines Rea

A Survey of Fifty-three US-based Oncologists

Panel Intelligence, LLC

June 2007

STUDY DESCRIPTION

OBJECTIVES

To quantify the potential impact of the CMS proposal on ESA usage by surveying a set of oncologists with large practices.

• Determine current practices in ESA treatment by patient type and cancer type.
• Estimate potential impact overall and by patient type and cancer type.
• Gauge physician reactions to proposed guidelines.
• Anticipate impact on treatment duration and baseline Hg levels.
• Understand importance and potential benefits of ESA usage with regard to quality of life.

Key Findings

• Proposal is “Too Stringent”: Among surveyed physicians, ninety-one percent indicate their ESA use will decrease by 49% on average if the CMS proposal is approved as currently written.  Over 80% suggest that the proposed guidelines are too restrictive.
• “Reasonable and Necessary” Treatment Population Limited: Among the forty percent of cancer patients receiving chemotherapy on average, about 56% have chemotherapy-induced anemia (CIA) and are therefore eligible for coverage of ESA treatment under the proposal.
• This represents roughly 22% of cancer patients potentially meeting the criteria for ESA treatment coverage before excluding those patients with myelodysplastic syndromes (MDS).
• On average, between 24% and 32% of oncology patients are currently receiving treatment with an ESA.
• Greatest Decrease in ESA Use Expected within MDS: Among CIA patients with MDS or leukemia, forty-six percent are currently receiving ESA treatment, representing the greatest percentage for any cancer type. Under the CMS proposal, ESA treatment would not be covered for this group of patients.
• Only 21% of MDS patients with CIA are expected to receive ESA treatment with approval of the CMS proposal, compared with the 46% of patients currently treated
• 28% of MDS patients with non-CIA anemia also receive ESA treatment and would not receive coverage under the proposal
• Quality of Life “Extremely Important” to Oncologists: When asked how important quality of life issues are with regard to considering ESA treatment, fifty-seven percent of surveyed physicians selected “Extremely important;” 85% of respondents indicate non-CIA patients who have received ESA treatment experienced improved quality of life in the form of reduced fatigue or reduced need for transfusions 
• Proposal Would Impact Baseline Hb Levels and Treatment Duration: While the CMS proposal calls for a baseline of 9 or 10 g/dL Hb to initiate treatment and a maximum of 12 weeks’ treatment duration, physicians currently administer ESAs at 10.3 g/dL, on average, and almost half treat patients with ESAs for more than 12 weeks on average.
• Aranesp® is Preferred ESA Among Surveyed Oncologists: While nearly eighty-five percent of respondents currently administer Procrit®, nearly all respondents (94%) administer Aranesp®.  Sixty-six percent of all respondents identified Aranesp as their single most preferred ESA.

Inclusion Criteria and Respondent Demographics

quantitative survey detailed findings by question

survey questions: additional data collected in screening

Screening Question 5.             

Please indicate the setting where you spend the majority of your clinical time.

Screening Question 6.             

Which of the following describes your primary practice setting?

Section 1: patient background

Question 1.             

In total, how many patients with cancer (regardless of cancer type) are you currently managing?

Total Cancer Patients under Management (n = 53)

Question 2.             

What types of cancer are your patients currently being treated for?

Tumor Types Treated – In Descending Order by Frequency

*GIST, leukemia lymphoma, mesothelioma, gall bladder, testicular

Question 3.             

Of your <insert value from Q1> patients, what percent are currently receiving chemotherapy?

Percent of Cancer Patients Receiving Chemotherapy (n = 53)

Question 4.             

Of your patients receiving chemotherapy, what percent have chemotherapy-induced anemia (CIA)?

Percent of Chemotherapy-treated Patients with CIA (n = 53)

section 2: current use of erythropoiesis-stimulating agents

Question 5.             

What percent of your cancer patients is currently being treated with an ESA?

Percent of Cancer Patients Receiving an ESA (n = 53)