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A systematic review and economic evaluation of epoetin alfa, epoetin beta and darbepoetin alfa in anaemia associated with cancer, especially that attributable to cancer treatment

Cancer-associated and cancer-treatment-associated anaemia are important problems which have been under appreciated in the past. Management has consisted of investigation of the cause of anaemia, monitoring, blood transfusions and treatment of the underlying cancer. Epoetin alfa, epoetin beta and darbepoetin alfa are three types of exogenous erythropoietin which stimulate the bone marrow to produce red blood cells. They are expensive, with each month of treatment costing around £1000, and patients often requiring 3-6 months of treatment. The cost of alternative treatment, such as red blood cell transfusion (RBCT), is also often underestimated, with the approximate cost per typical transfusion (2 or 3 units), including administration, but not cost to patient and donor, recently being estimated as £635. Increasing scarcity of blood is a further concern.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2007

Epoetin alfa improves quality of life in patients with cancer: results of a metaanalysis

BACKGROUND: Anemia in patients with cancer causes fatigue, weakness, and impaired concentration, negatively impacting quality of life (QOL). In clinical trials involving patients with cancer who had varied characteristics, it has been shown that epoetin alfa treatment increased hemoglobin levels and improved QOL. A systematic review and metaanalysis of data from those trials was conducted to summarize existing knowledge on the role of epoetin alfa in improving QOL for anemic patients with cancer.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

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

The authors concluded that epoetin α treatment of anaemia in various conditions had a statistically and clinically significant impact on health-related quality of life, particularly fatigue. In light of the possibility of error and bias in the review process, and the unclear quality of the included studies, the authors’ conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

The relative safety and effectiveness of different epoetin drugs for treating anaemia in people with chronic kidney disease

Several drugs are available to treat anaemia for people who have kidney disease but whether these drugs are similar or different in their ability to improve symptoms of anaemia, such as tiredness and breathlessness, and whether they are equally safe based on their risks of causing a stroke or a heart attack, is not clear. This is because research studies that compare the effects of one drug directly with another are not common. We have found 56 studies that measure the safety and how these drugs help to improve how patients who have kidney disease feel, function and survive that have involved 15,596 people. Our last search of the literature was in February 2014.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Methoxy polyethylene glycol-epoetin beta versus darbepoetin alfa for anemia in non-dialysis-dependent CKD: a systematic review

BACKGROUND: Anemia management in non-dialysis-dependent chronic kidney disease (CKD) patients is associated with cardiovascular and cost benefits, slows decline in renal function, and prevents mortality. Different reviews have focused on evaluating the safety and efficacy of methoxy polyethylene glycol-epoetin beta (MPG-EPO), a continuous erythropoietin receptor activator, in CKD patients regardless of dialysis dependency and others have studied this novel agent exclusively in CKD patients receiving dialysis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Darbepoetin alfa to treat anaemia in people with chronic kidney disease

People who have chronic kidney disease (CKD) frequently experience anaemia. Several different medicines that treat anaemia are available including darbepoetin alfa.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

A meta-analysis of the relative doses of erythropoiesis-stimulating agents in patients undergoing dialysis

Bibliographic details: Bonafont X, Bock A, Carter D, Brunkhorst R, Carrera F, Iskedjian M, Molemans B, Dehmel B, Robbins S.  A meta-analysis of the relative doses of erythropoiesis-stimulating agents in patients undergoing dialysis. NDT Plus 2009; 2(5): 347-353

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

[Effectivity of erythropoietin in autologous blood transfusion for bleeding surgery: applications to orthopedic surgery]

Bibliographic details: Aguado Romeo M J, Villegas Portero R.  [Effectivity of erythropoietin in autologous blood transfusion for bleeding surgery: applications to orthopedic surgery]. [Efectividad de la eritropoyetina en la autodonacion de sangre para la cirugia sangrante: aplicaciones en la cirugia ortopedica.] Madrid, Spain: Ministerio de Sanidad y Consumo. AETSA; 2006/36. 2007

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Drugs for Chronic Hepatitis C Infection: Cost-Effectiveness Analysis [Internet]

The objective of this study was to assess the comparative cost effectiveness of regimens for the treatment of chronic hepatitis C (CHC) infection (genotypes 1 to 4).

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: January 2016
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Drugs for Chronic Hepatitis C Infection: Clinical Review [Internet]

The objective of this systematic review was to assess the comparative efficacy and safety of currently available and emerging regimens for the treatment of chronic hepatitis C (CHC) infection (genotypes 1 to 6).

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: January 2016
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Anaemia Management in Chronic Kidney Disease: Partial Update 2015 [Internet]

Anaemia is defined internationally as a state in which the quality and/or quantity of circulating red blood cells is below normal. Blood haemoglobin (Hb) concentration serves as the key indicator for anaemia because it can be measured directly and has an international standard. In response to low tissue oxygen levels in anaemia the kidney produces the hormone erythropoietin which stimulates the bone marrow to produce red blood cells. A major cause of the anaemia of chronic kidney disease (CKD) is a reduction in erythropoietin production due to kidney damage.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: June 2015
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The Diagnosis and Treatment of Lung Cancer (Update)

This guidance updates and replaces NICE clinical guideline 24 (published February 2005).

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: April 2011
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Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for advanced recurrent or refractory ovarian cancer: a systematic review and economic evaluation

The study was unable to compare the clinical and cost-effectiveness of platinum-based therapies with non-platinum-based therapies for platinum sensitive ovarian cancer. In people with platinum-sensitive disease, paclitaxel plus platinum could be considered cost-effective compared with platinum therapies alone at a threshold of £30,000 per additional quality-adjusted life-year. In people with disease which is resistant or refractory to platinum it is unlikely that topotecan would be considered cost-effective compared with pegylated liposomal doxorubicin hydrochloride.

Health Technology Assessment - NIHR Journals Library.

Version: January 2015
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Fatigue (PDQ®): Health Professional Version

Expert-reviewed information summary about fatigue, a condition marked by extreme tiredness and inability to function because of lack of energy, often seen as a complication of cancer or its treatment.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: January 13, 2017

Myeloma: Diagnosis and Management

The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: February 2016
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Assessment of the Need to Update Comparative Effectiveness Reviews: Report of an Initial Rapid Program Assessment (2005–2009) [Internet]

AHRQ recognizes that periodic assessments of the evidence base supporting each of the comparative effectiveness reviews is an important and necessary part of the Effective Health Care (EHC) Program. The rapidity with which new research findings accumulate makes it imperative that the evidence be assessed periodically to determine the need for a full-scale update. The EHC Program, then, initiated concurrent and parallel work to address this need both methodologically and programmatically. The development of methods guidance for updating was initiated to inform the research of systematic reviewers. This methodologic guidance will supplement the EHC Methods Guide for Comparative Effectiveness Reviews (www.effectiveheathcare.gov). In parallel with the methods effort, an initial, rapid program assessment was commissioned to assess the need for the findings of the CERs completed to that point to be updated. The Southern California Evidence-based Practice Center (SCEPC) was tasked with conducting this assessment. Findings from the assessment were presented to AHRQ for consideration within the usual program criteria to prioritize the topics for updating within the EHC Program. This document presents the findings from the assessment for public information and transparency.

Agency for Healthcare Research and Quality (US).

Version: September 10, 2009
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Direct-Acting Antiviral Agents for Chronic Hepatitis C Genotype 1 [Internet]

An estimated 250,000 Canadians have chronic hepatitis C virus (HCV) infection; however, the exact number affected is not known, as 30% to 70% of patients are unaware that they have been infected and limited population level surveillance has been carried out in Canada to document prevalent cases. While the incidence of HCV infection in the US and Canada appears to be stable or declining, liver-related morbidity and mortality are expected to increase over the coming decades, as those who are already infected age and develop progressive liver disease.

CADTH Therapeutic Review - Canadian Agency for Drugs and Technologies in Health.

Version: October 2014
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Blood Transfusion

This guideline contains recommendations about general principles of blood transfusion, and applies to a range of conditions and different settings. It does not include recommendations relating to specific conditions and provides guidance on:

NICE Guideline - National Clinical Guideline Centre (UK).

Version: November 2015
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Registries for Evaluating Patient Outcomes: A User's Guide [Internet]. 3rd edition

This User's Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care.

Agency for Healthcare Research and Quality (US).

Version: April 2014
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Pharmacist-Led Chronic Disease Management: A Systematic Review of Effectiveness and Harms Compared to Usual Care [Internet]

Increased involvement of clinical pharmacists in patient care may offer increased access to health care and improved patient outcomes. Defined by Hepler and Strand in 1989, pharmaceutical care involves pharmacist collaboration with health team members to optimize therapeutic outcomes by identifying, solving, and preventing actual and potential drug therapy problems. Since 1995, the Department of Veterans Affairs has allowed Clinical Pharmacy Specialists (CPS) an expanded scope of practice with independent prescribing privileges. In this capacity, CPS have been detailed to perform “pharmaceutical care” or comprehensive medication management along with chronic disease state management services, in addition to less complex services such as patient medication counseling or responding to drug information questions. In the VA primary care setting, CPS are likely to be responsible for therapeutic outcomes for a multitude of conditions for any patient referred to CPS or proactively identified by CPS as a high-risk patient.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: October 2015
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