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
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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.
KeywordsNon-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  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.
- 3.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
- 4.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.2009.2023.5622Google Scholar
- 5.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 29:3825–3831PubMedCrossRefGoogle Scholar
- 6.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 25:5506–5518PubMedCrossRefGoogle Scholar
- 8.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 59:1–11PubMedCrossRefGoogle Scholar
- 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 34:241–246PubMedCrossRefGoogle Scholar
- 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 74:529–534PubMedCrossRefGoogle Scholar
- 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 22:1805–1811PubMedCrossRefGoogle Scholar
- 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 15:526–536PubMedCrossRefGoogle Scholar
- 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 22:2310–2319PubMedCrossRefGoogle Scholar
- 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 7:903–909PubMedCrossRefGoogle Scholar
- 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 208PubMedCrossRefGoogle Scholar
- 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 18:324–330PubMedCrossRefGoogle Scholar
- 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 6:161–168PubMedCrossRefGoogle Scholar