Impact of limiting erythropoiesis-stimulating agent use for chemotherapy-induced anemia on the United States blood supply margin

BACKGROUND: Recently, the Centers for Medicare and Medicaid Services issued a national coverage determination that limited erythropoiesis-stimulating agents (ESAs) utilization in patients with chemotherapy-induced anemia (CIA). This study evaluated the impact of limiting the use of ESAs for CIA on the US blood supply margin. STUDY DESIGN AND METHODS: A modeling simulation was employed to compare the number of red blood cell (RBC) units transfused in CIA patients treated with ESAs to the number of RBC units that would be transfused if ESAs were limited or discontinued. The excess number of RBC units that would be required with limited ESA treatment was contrasted with the available marginal blood supply from 2004 and 2008. Model inputs were obtained from published literature or empirical evidence when published information was unavailable. RESULTS: The model predicted that up to 18 and 15 percent of the respective 2004 and 2008 marginal US blood supply would be required to cover the incremental demand for blood that would arise from a 25 percent decrease in ESA use. For ESA use reductions of 50 and 75 percent, the model predicted 17 to 21 percent (134,667 units) and 26 to 31 percent (202,001 units) of the 2008 and 2004 marginal US blood supply would be required, respectively. CONCLUSION: This study showed that limiting ESA use in CIA patients would impose considerable pressure on the available blood supply margin given the small margin between usable blood and transfusion demand. The public health consequences of such an outcome should be taken into account when revisions to ESA use are being considered.