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Chemotherapy Administration

Modelling the Costs of Alternative Protocols

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Abstract

Background and Objective

The increasing cost of chemotherapy is placing greater pressures on limited healthcare budgets. A potentially important, but often overlooked, aspect of chemotherapy is the cost associated with administration. This study aims to develop a better understanding of these costs, and in doing so, develop a model to estimate the comparative cost of administering alternative chemotherapy protocols for economic evaluation or local decision making.

Methods

We identified the potential tasks and choices related to administering intravenous chemotherapy, grouped tasks according to anticipated resource use, and allocated costs to each task using data from an evidence-based collection of cancer protocols or from primary data collection. The resources were costed from a healthcare system perspective using standard data sources within Australia. The model was applied to alternative protocols used in the treatment of three different cancers: locally advanced and metastatic non-small-cell lung cancer, adjuvant colorectal cancer and adjuvant breast cancer.

Results

For the three cancer types examined, the cost of completed administration ranged from 1274 Australian dollars ($A) to $A3015 (year 2009 values) for 13 different protocols potentially used for the initial treatment of locally advanced and metastatic non-small-cell lung cancer; $A5175–8445 for seven protocols for adjuvant colorectal cancer treatment; and $A1494–4074 for seven protocols for adjuvant breast cancer treatment.

Conclusions

The results are of practical significance to those undertaking economic evaluations and to decision makers who use this information within the area of chemotherapy. The examples used suggest that administration costs per visit varied inversely with the number of visits. The results provide information where little has previously been available and may allow decisions about costs and resource allocation to be made with more certainty. Although our model uses costs from the public health system within an Australian state (New South Wales), it can be adapted for use in other jurisdictions.

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Acknowledgements

Funding for this study was provided by the National Health and Medical Research Council (NHMRC) through a research programme grant (no. 455366). This study has been neither approved nor reviewed by the NHMRC. Earlier versions of this work were presented at the 31st Australian Health Economics Society (AHES) Conference and the 6th Health Services and Policy Conference, and the authors are grateful for comments made by the participants.

Dr Haywood consults for the economic evaluations for the Australian Pharmaceutical Benefits Advisory Committee (PBAC). Professor Ward serves on two Commonwealth committees (the PBAC and the Medical Services Advisory Committee of Australia), which advise Government on the funding of services and drugs. The remaining authors have no conflicts of interest to declare.

Dr Haywood was the lead author and created the overall design and the initial draft. Dr van Gool, Professor Haas, Professor Pearson and Professor Ward contributed to the study design. Data collection and evaluation were conducted by Dr Faedo, Dr Gallego and Mr de Raad. Cost calculations were undertaken by Dr Haywood, Dr Gallego, Dr van Gool and Mr de Raad. All authors contributed to the drafting and revision of the manuscript.

Dr Haywood is the guarantor of the overall content of this article.

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Authors and Affiliations

  1. Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, P.O. Box 123, Broadway, Sydney, NSW, 2007, Australia

    Philip Haywood, Kees van Gool, Marion Haas & Gisselle Gallego

  2. Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Pharmacotherapy, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands

    Johan de Raad

  3. Faculty of Medicine, University of New South Wales, Prince of Wales Clinical School, Sydney, NSW, Australia

    Sallie-Anne Pearson, Margaret Faedo & Robyn Ward

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  1. Philip Haywood
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Correspondence to Philip Haywood.

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Haywood, P., de Raad, J., van Gool, K. et al. Chemotherapy Administration. PharmacoEconomics 30, 1173–1186 (2012). https://doi.org/10.2165/11597280-000000000-00000

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