Supportive Care in Cancer

, Volume 21, Issue 6, pp 1665–1675 | Cite as

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

  • Angela Ihbe-HeffingerEmail author
  • B. Paessens
  • K. Berger
  • M. Shlaen
  • R. Bernard
  • C. von Schilling
  • C. Peschel
Original Article



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.


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).


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.


Non-small-cell lung carcinoma Cancer chemotherapy Side effects Treatment costs Medical care costs 



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.

Conflict of interests

Angela Ihbe-Heffinger: Research grants (Lilly, Amgen, Germany), lecturing fees (Amgen, Germany); all other authors declared no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Angela Ihbe-Heffinger
    • 1
    • 2
    Email author
  • B. Paessens
    • 1
  • K. Berger
    • 3
    • 4
  • M. Shlaen
    • 4
  • R. Bernard
    • 1
  • C. von Schilling
    • 5
    • 6
  • C. Peschel
    • 5
  1. 1.Hospital Pharmacy Department, Klinikum rechts der IsarTechnische Universität MünchenMünchenGermany
  2. 2.Department of Gynaecology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  3. 3.Department of Transfusion Medicine and HaemostaseologyKlinikum der Universität MünchenMunichGermany
  4. 4.Health Economics & Outcomes ResearchIMS HEALTH GmbHMunichGermany
  5. 5.Third Medical Department, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  6. 6.Department of Internal Medicine IIIKlinikum FreisingFreisingGermany

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