Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine

Abstract

The costs of chemotherapy toxicity were analyzed in patients with relapsed low-grade non-Hodgkin's lymphoma (NHL). A total of 91 specialists regularly treating NHL were interviewed by telephone to identify the most commonly used treatment regimens. Retrospective case record forms providing data on 424 patients with relapsed low-grade NHL were used to assess adverse event (AE) frequency and management. Data on one cycle of treatment was collected for each patient, and unit costs were assessed and extrapolated for six cycles to estimate AE costs for an average course of treatment. Average AE management costs were evaluated by country and treatment regimen. Toxicity costs were substantial for the most commonly used chemotherapy regimens, namely CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), COP/CVP (cyclophosphamide, vincristine, prednisone), and fludarabine therapies. In Canada CHOP-associated AEs costs (EUR 5.036 per patient) were more than twofold greater than drug acquisition costs, and cost more than AEs associated with COP/CVP (EUR 3.252) or fludarabine (EUR 1.273). In Germany CHOP-associated AE costs (EUR 2.515) were comparable to to those associated with COP/CVP (EUR 2.658). In Italy CHOP-associated AE costs (EUR 2.179) were considerably less than those associated with fludarabine treatment (EUR 4.908). Neutropenia and fever/infection AEs were the most common and more expensive to treat than nausea and vomiting, anaemia, thrombocytopenia, or other AEs in all three countries. This study shows that management of neutropenia and fever/infection are the most expensive AE costs associated with conventional chemotherapeutic treatment of relapsed low-grade NHL. AE management costs are substantial and are likely to be an important cost driver in all countries.

Management of Febrile Neutropenia – a German Prospective Hospital Cost Analysis in Lymphoproliferative Disorders, Non-Small Cell Lung Cancer, and Primary Breast Cancer

“…FullpublisheddataontheburdenofdiseaseinGermanyafter the introduction of German Diagnosis-Related Groups (GDRGs)in2004arenotavailable.Froma1998Germanhealth insurance perspective, € 2,396 mean FL-associated costs occurredin13smallcelllungcancerpatients(SCLC),aswere € 3,192 in 26 non-Hodgkin's lymphoma (NHL) patients per episodewithneutropenia,fever,and/orinfections [15,16]. CostAnalysisofFebrileNeutropenia 245 studyconfirmsthatFN/FLhasconsiderableeconomicconsequences for German hospitals.…”

Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients

“…147 [12] ( 128 [14] (98-158) results from purely theoretical approaches like the recently published papers on the cost-effectiveness of pegfilgrastim versus filgrastim before reaching definite conclusions [31][32][33]. Similarly, asymmetric distribution of cost has been shown for FN [7], CT-induced thrombocytopenia and bleeding [16].…”

“…For European health care systems and especially for Germany, microeconomic data on supportive care interventions are scarce [11,12]. The existing health economic literature, mainly studies from the United States, focuses on particular toxic effects such as anaemia [11,13], febrile neutropenia (FN) [7,14,15], thrombocytopenia and bleeding [16,17], mucositis [18] and CT-induced nausea and vomiting [2].…”

Economic Analysis of Alemtuzumab (MabCampath®) in Fludarabinerefractory Chronic Lymphocytic Leukemia

“…Resources for administering agents were based on Ontario guidelines. Thrombocytopenia and neutropenia costs were based on a study of NHL patients who were treated with fludarabine [35]. The rate of CMV infection/reactivation and all grade III and IV adverse drug reactions for alemtuzumab was based on the Stilgenauer study.…”

“…Cost of treating a rash consisted of four weeks treatment with: topical clindamycin 2% ($0.862); hydrocortisone 1% lotion ($0.1462); oral minocycline 100mg twice daily ($1.0332 per 100mg) [34]. Cost of nausea/vomiting and neutropenia were based on a study of non-Hodgkin's lymphoma patients treated with fludarabine [35]. Grade III and IV fever or infections from the FC study were assumed to be neutropenia.…”