Patterns of erythropoiesis-stimulating agent use among Medicare beneficiaries with myelodysplastic syndromes and consistency with clinical guidelines

Abstract

Erythropoiesis-stimulating agents (ESA) are used commonly to reduce symptomatic anemia in patients with myelodysplastic syndromes (MDS). We assessed population-based patterns of ESA use relative to treatment guidelines using data from the Surveillance, Epidemiology, and End Results (SEER) registries, with linked Medicare claims providing detailed treatment data from 2001 through 2005. The study found widespread use (62%) of ESA in Medicare beneficiaries with MDS. Similar ESA use rates regardless of risk status, low frequency (45%) of serum erythropoietin determination prior to ESA initiation, and high prevalence (60.4%) of short-duration ESA episodes suggest clinically important discrepancies between actual practice and guideline-recommended therapy.

Figure 1

Duration of erythropoiesis stimulating agent episodes and distribution of myelodysplastic syndrome patients by number and duration of episodes^*,† Figure 1A Distribution of MDS patients by number, duration of ESA episodes □ All episodes < 8 weeks One episode >= 8 weeks Multiple episodes >= 8 weeks ■ Multiple episodes, mixed length Figure 1B Distribution of ESA episodes by duration, agent □ < 8 weeks 8–15 weeks 16–31 weeks ■ 32–63 weeks 64+ weeks * Source: SEER-Medicare, cases from 2001–2005, claims from 2000–2007 † Abbreviations: ESA, erythropoiesis stimulating agents; SEER, Surveillance, Epidemiology and End Results