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Supportive Care in Cancer

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01-06-2013 | Original Article

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

Authors: Angela Ihbe-Heffinger, B. Paessens, K. Berger, M. Shlaen, R. Bernard, C. von Schilling, C. Peschel

Published in: Supportive Care in Cancer | Issue 6/2013

Abstract

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.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2008) Estimates of worldwide burden of cancer in 2008: Globocan 2008. Int J Cancer 127:2893–2917CrossRef

Travis WD, Travis LB, Devesa SS (1995) Lung cancer. Cancer 75:191–202PubMedCrossRef

Non-small cell lung cancer treatment (pdq®): http://wwwcancergov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional, National Cancer Institute at the National Institutes of Health, 2011

Azzoli CG, Baker S, Jr, Temin S, Pao W, Aliff T, Brahmer J, Johnson DH, Laskin JL, Masters G, Milton D, Nordquist L, Pfister DG, Piantadosi S, Schiller JH, Smith R, Smith TJ, Strawn JR, Trent D, Giaccone G (2009) American Society of Clinical Oncology Clinical Practice guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol 27: published ahead of print on November 23, 2009 as 2010.1200/JCO.2009.2023.5622

Azzoli CG, Temin S, Aliff T, Baker S Jr, Brahmer J, Johnson DH, Laskin JL, Masters G, Milton D, Nordquist L, Pao W, Pfister DG, Piantadosi S, Schiller JH, Smith R, Smith TJ, Strawn JR, Trent D, Giaccone G (2011) 2011 focused update of 2009 American Society of Clinical Oncology Clinical Practice guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol 29:3825–3831PubMedCrossRef

Pisters KM, Evans WK, Azzoli CG, Kris MG, Smith CA, Desch CE, Somerfield MR, Brouwers MC, Darling G, Ellis PM, Gaspar LE, Pass HI, Spigel DR, Strawn JR, Ung YC, Shepherd FA (2007) Cancer Care Ontario and American Society of Clinical Oncology adjuvant chemotherapy and adjuvant radiation therapy for stages I–IIIA resectable non small-cell lung cancer guideline. J Clin Oncol 25:5506–5518PubMedCrossRef

Felip E, Gridelli C, Baas P, Rosell R, Stahel R (2011) Metastatic non-small-cell lung cancer: Consensus on pathology and molecular tests, first-line, second-line, and third-line therapy: 1st ESMO consensus conference in lung cancer; Lugano 2010. Ann Oncol 22:1507–1519PubMedCrossRef

Rajeswaran A, Trojan A, Burnand B, Giannelli M (2008) Efficacy and side effects of cisplatin- and carboplatin-based doublet chemotherapeutic regimens versus non-platinum-based doublet chemotherapeutic regimens as first line treatment of metastatic non-small cell lung carcinoma: a systematic review of randomized controlled trials. Lung Cancer 59:1–11PubMedCrossRef

D'Addario G, Pintilie M, Leighl NB, Feld R, Cerny T, Shepherd FA (2005) Platinum-based versus non-platinum-based chemotherapy in advanced non-small-cell lung cancer: a meta-analysis of the published literature. J Clin Oncol 23:2926–2936PubMedCrossRef

10.

Cella DF, Patel JD (2008) Improving health-related quality of life in non-small-cell lung cancer with current treatment options. Clin Lung Cancer 9:206–212PubMedCrossRef

11.

Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J (2008) Health state utilities for non small cell lung cancer. Health Qual Life Outcomes 6:84PubMedCrossRef

12.

Stokes ME, Muehlenbein CE, Marciniak MD, Faries DE, Motabar S, Gillespie TW, Lipscomb J, Knopf KB, Buesching DP (2009) Neutropenia-related costs in patients treated with first-line chemotherapy for advanced non-small cell lung cancer. J Manag Care Pharm 15:669–682PubMed

13.

Ihbe-Heffinger A, Paessens BJ, von Schilling C, Shlaen M, Gottschalk N, Berger K, Bernard R, Kiechle M, Peschel C, Jacobs VR (2011) Management of febrile neutropenia—a German prospective hospital cost analysis in lymphoproliferative disorders, non-small cell lung cancer, and primary breast cancer. Onkologie 34:241–246PubMedCrossRef

14.

Mayordomo JI, Lopez A, Vinolas N, Castellanos J, Pernas S, Domingo Alonso J, Frau A, Layola M, Antonio Gasquet J, Sanchez J (2009) Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain. Curr Med Res Opin 25:2533–2542PubMedCrossRef

15.

Banz K, Bischoff H, Brunner M, Chouaid C, de Castro Carpeno J, de Marinis F, Grossi F, Vergnenegre A, Walzer S (2011) Comparison of treatment costs of grade 3/4 adverse events associated with erlotinib or pemetrexed maintenance therapy for patients with advanced non-small-cell lung cancer (NSCLC) in Germany, France, Italy, and Spain. Lung Cancer 74:529–534PubMedCrossRef

16.

Schiller J, Tilden D, Aristides M, Lees M, Kielhorn A, Maniadakis N, Bhalla S (2004) Retrospective cost analysis of gemcitabine in combination with cisplatin in non-small cell lung cancer compared to other combination therapies in Europe. Lung Cancer 43:101–112PubMedCrossRef

17.

Bischoff HG, Heigener DF, Walzer S, Nuijten M (2010) Costs of bevacizumab and pemetrexed for advanced non-squamous NSCLC in Italy and Germany. Lung Cancer 69(Suppl 1):S18–S23PubMedCrossRef

18.

Chouaid C, Atsou K, Hejblum G, Vergnenegre A (2009) Economics of treatments for non-small cell lung cancer. PharmacoEconomics 27:113–125PubMedCrossRef

19.

Neymark N, Lianes P, Smit EF, van Meerbeeck JP (2005) Economic evaluation of three two-drug chemotherapy regimens in advanced non-small-cell lung cancer. PharmacoEconomics 23:1155–1166PubMedCrossRef

20.

Horgan AM, Bradbury PA, Amir E, Ng R, Douillard JY, Kim ES, Shepherd FA, Leighl NB (2011) An economic analysis of the interest trial, a randomized trial of docetaxel versus gefitinib as second-/third-line therapy in advanced non-small-cell lung cancer. Ann Oncol 22:1805–1811PubMedCrossRef

21.

Weissflog D, Matthys H, Hasse J, Virchow JC Jr (2001) Epidemiology and costs of lung cancer in Germany. Pneumologie 55:333–338PubMedCrossRef

22.

Ihbe-Heffinger A, Ehlken B, Bernard R, Berger K, Peschel C, Eichler HG, Deuson R, Thodtmann J, Lordick F (2004) The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers. Ann Oncol 15:526–536PubMedCrossRef

23.

Paessens BJ, von Schilling C, Berger K, Shlaen M, Muller-Thomas C, Bernard R, Peschel C, Ihbe-Heffinger A (2011) Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients. Ann Oncol 22:2310–2319PubMedCrossRef

24.

Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, Scher HI, Schrag D (2006) Patient versus clinician symptom reporting using the national cancer institute common terminology criteria for adverse events: results of a questionnaire-based study. Lancet Oncol 7:903–909PubMedCrossRef

25.

Grunberg SM, Deuson RR, Mavros P, Geling O, Hansen M, Cruciani G, Daniele B, De Pouvourville G, Rubenstein EB, Daugaard G (2004) Incidence of chemotherapy-induced nausea and emesis after modern antiemetics. Cancer 100:2261–2268PubMedCrossRef

26.

The Uppsala Monitoring Centre: The use of the WHO–UMC system for standardised case causality assessment: http://wwwwho-umcorg/graphics/4409.pdf, 2007, 2009

27.

Comella P, Panza N, Manzione L, De Cataldis G, Cioffi R, Maiorino L, Lorusso V, Lamberti A, Micillo E, Natale M, Bilancia D, Nicolella G, Di Nota A, Mancarella S, Frasci G, Comella G (2000) Interim analysis of a phase III trial comparing cisplatin, gemcitabine, and vinorelbine vs. either cisplatin and gemcitabine or cisplatin and vinorelbine in advanced non small-cell lung cancer. A Southern Italy Cooperative Oncology Group study. Clin Lung Cancer 1:202–207, discussion 208PubMedCrossRef

28.

Comella P, Filippelli G, De Cataldis G, Massidda B, Frasci G, Maiorino L, Putzu C, Mancarella S, Palmeri S, Cioffi R, Roselli M, Buzzi F, Milia V, Gambardella A, Natale D, Bianco M, Ghiani M, Masullo P (2007) Efficacy of the combination of cisplatin with either gemcitabine and vinorelbine or gemcitabine and paclitaxel in the treatment of locally advanced or metastatic non-small-cell lung cancer: a Phase III randomised trial of the Southern Italy Cooperative Oncology Group (SICOG 0101). Ann Oncol 18:324–330PubMedCrossRef

29.

Dedes KJ, Szucs TD, Bodis S, Joerger M, Lowy A, Russi EW, Steinert HC, Weder W, Stahel RA (2004) Management and costs of treating lung cancer patients in a university hospital. PharmacoEconomics 22:435–444PubMedCrossRef

30.

Vergnenegre A, Corre R, Berard H, Paillotin D, Dujon C, Robinet G, Crequit J, Bota S, Thomas P, Chouaid C (2011) Cost-effectiveness of second-line chemotherapy for non-small cell lung cancer: an economic, randomized, prospective, multicenter phase III trial comparing docetaxel and pemetrexed: the GFPC 05-06 study. J Thorac Oncol 6:161–168PubMedCrossRef

Title: 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
Authors: Angela Ihbe-Heffinger
B. Paessens
K. Berger
M. Shlaen
R. Bernard
C. von Schilling
C. Peschel
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 6/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-012-1711-5

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