TY - JOUR
T1 - The impact of chemotherapy-induced side effects on medical care usage and cost in German hospital care - An observational analysis on non-small-cell lung cancer patients
AU - Ihbe-Heffinger, Angela
AU - Paessens, B.
AU - Berger, K.
AU - Shlaen, M.
AU - Bernard, R.
AU - Von Schilling, C.
AU - Peschel, C.
N1 - Funding Information:
Acknowledgments We thank Volker Claus (PhD, BBA) for assistance in table and figure preparation (Health Economics & Outcomes Research, IMS HEALTH GmbH, München, Germany) and the study centres for participation. Subanalysis of the investigator sponsored study [23] and editorial assistance was supported by the Lilly Deutschland GmbH, Bad Homburg, Germany. The study sponsor was not involved in the study design, data collection, in the analysis and interpretation of data, in the writing of the manuscript and in the decision to submit the manuscript for publication.
PY - 2013/6
Y1 - 2013/6
N2 - Purpose: To evaluate frequency and severity of adverse drug reactions (ADRs) and its economic consequences after standard dose (immuno-)chemotherapy (CT) of non-small-cell lung cancer (NSCLC). Patients and methods: Subanalysis of a prospective, multicentre, longitudinal, observational cohort study; data were collected from patient interviews and pre-planned chart reviews. Costs were aggregated per CT line and presented from provider perspective. Results: A total of 120 consecutive NSCLC patients (mean age, 63.0 ± 8.4 (SD) years; men, 64.2 %; ECOG (Eastern Cooperative Oncology Group) performance status <2, 84.3 %; tumour stage III/IV, 85 %; history of comorbidity, 93.3 %) receiving 130 CT lines were evaluated. 80 % of CT lines were associated with grade 3 or 4 ADRs, 22.3 % developed potential life-threatening complications, 77.7 % were associated with at least one hospital stay (inpatient, 63.9 %; outpatient/day clinic 39.2 %, ICU 6.9 %), with a mean cumulative number of 12.8 (±14.0 SD) hospital days. Mean (median) toxicity management costs per CT line (TMC-TL) amounted to €3,366 (€1,406) and were found to be higher for first-line compared to second-line treatment: €3,677 (€1,599) vs. €2,475 (€518). TMC-TL were particularly high in CT lines with ICU care €12,207 (€9,960). Eight out of 11 ICU stays were associated with grade 3 or 4 infections. Nine CT lines with ICU care accounted for 25 % of total expenses (€109,861 out of €437,580). Conclusions: In first-line NSCLC treatment, in particular, CT toxicity management is expensive. Asymmetric cost distribution seems to be triggered by infection associated ICU care. Its avoidance should reduce patients' clinical burden and have considerable economic implications. Nevertheless, comparative observational studies have to confirm estimated savings.
AB - Purpose: To evaluate frequency and severity of adverse drug reactions (ADRs) and its economic consequences after standard dose (immuno-)chemotherapy (CT) of non-small-cell lung cancer (NSCLC). Patients and methods: Subanalysis of a prospective, multicentre, longitudinal, observational cohort study; data were collected from patient interviews and pre-planned chart reviews. Costs were aggregated per CT line and presented from provider perspective. Results: A total of 120 consecutive NSCLC patients (mean age, 63.0 ± 8.4 (SD) years; men, 64.2 %; ECOG (Eastern Cooperative Oncology Group) performance status <2, 84.3 %; tumour stage III/IV, 85 %; history of comorbidity, 93.3 %) receiving 130 CT lines were evaluated. 80 % of CT lines were associated with grade 3 or 4 ADRs, 22.3 % developed potential life-threatening complications, 77.7 % were associated with at least one hospital stay (inpatient, 63.9 %; outpatient/day clinic 39.2 %, ICU 6.9 %), with a mean cumulative number of 12.8 (±14.0 SD) hospital days. Mean (median) toxicity management costs per CT line (TMC-TL) amounted to €3,366 (€1,406) and were found to be higher for first-line compared to second-line treatment: €3,677 (€1,599) vs. €2,475 (€518). TMC-TL were particularly high in CT lines with ICU care €12,207 (€9,960). Eight out of 11 ICU stays were associated with grade 3 or 4 infections. Nine CT lines with ICU care accounted for 25 % of total expenses (€109,861 out of €437,580). Conclusions: In first-line NSCLC treatment, in particular, CT toxicity management is expensive. Asymmetric cost distribution seems to be triggered by infection associated ICU care. Its avoidance should reduce patients' clinical burden and have considerable economic implications. Nevertheless, comparative observational studies have to confirm estimated savings.
KW - Cancer chemotherapy
KW - Medical care costs
KW - Non-small-cell lung carcinoma
KW - Side effects
KW - Treatment costs
UR - http://www.scopus.com/inward/record.url?scp=84879150696&partnerID=8YFLogxK
U2 - 10.1007/s00520-012-1711-5
DO - 10.1007/s00520-012-1711-5
M3 - Article
C2 - 23338228
AN - SCOPUS:84879150696
SN - 0941-4355
VL - 21
SP - 1665
EP - 1675
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 6
ER -
