Neutropenic infections add significant costs to palliative chemotherapy in breast cancer.
BACKGROUND
The key clinical question in treating cancer patients for palliation is balancing issues on efficacy, toxicity and cost. The costs of chemotherapy have risen substantially during recent years, yet many patients are treated even at the end of their life with unresponsive cancer. The objective of this study was to determine the additional treatment costs during six months on chemotherapy to manage toxicity.


METHODS
Thirty-eight women were treated for metastatic breast cancer with an epirubicin-docetaxel regimen every three weeks. The clinical benefit was calculated for responding and stable patients maintaining the same status for at least 6 months (% of evaluable patients). Data on the use of medical resources were extracted from the hospital records. Health resources utilization analyses included the costs in Euros at year 2000 values during the six months' treatment of all additional hospitalization, drugs and blood transfusions.


RESULTS
The response rate (CRIPR) was 54% (95% CI 37-71). Seventy per cent of the patients (95% CI 53-84) had objective clinical benefit. The crude cost of the treatment was 12,416 Euros per patient. The total cost of chemotherapy per patient was 14,915 Euros. The costs of hospital stays, antibiotics, granulocyte growth factors and blood transfusions when indicated added 2,499 Euros per patient, thus adding 20% to crude treatment costs.


CONCLUSIONS
The treatment of advanced breast cancer with 3-weekly epirubicin-docetaxel combination requires additional use of health resources mainly due to infections. The clinical benefit and true cost rates should be reported with the results of novel schedules.
Korpela
Jaana
J
Department of Oncology, Turku University Hospital, Finland.
Salminen
Eeva
E
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D005260:Female; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000191:economics / Q000209:etiology*; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications / Q000191:economics*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics; D010166:Palliative Care / Q000191:economics*; D043823:Taxoids
D000890:Anti-Infective Agents; D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D017239:Paclitaxel