The cost of chemotherapy-induced nausea and vomiting in Italy.
OBJECTIVE
The aim of this paper is to analyze the costs of chemotherapy-induced nausea and vomiting (CINV) in Italy.


METHODS
In this prospective observational study at seven public oncology centers, incidence and intensity of CINV daily for 8 days after chemotherapy in consecutive patients receiving cisplatin-containing chemotherapy were recorded. All costs related to CINV (direct medical, direct nonmedical, and indirect) were recorded (in 2003 euros).


RESULTS
A total of 172 patients were enrolled; cost data were available for 168 patients. Thirty-seven percent of patients experienced acute CINV, and 57% experienced delayed CINV; 39% achieved total control, defined as no nausea, vomiting, or rescue therapy. Mean per-patient costs of acute and delayed CINV were 30.03 euro from the hospital perspective, 4.9 euro from the patient perspective, and 26.85 euro from the National Health Service (NHS) perspective. Costs of CINV were highly variable among oncology centers, largely because of differences in procedures for preventing delayed CINV. These costs were four times higher when antiemetic drugs were prescribed and paid for by the NHS than when antiemetic prophylaxis was provided directly from hospital pharmacies. Moreover, in the delayed phase, the NHS incurred a 94% increase in costs for patients without total control. Overall costs for patients who did not experience total control of CINV were 35.57 euro higher than for those who did (85% increase).


CONCLUSIONS
Costs of CINV for the Italian NHS could be reduced if hospitals furnished antiemetic prophylaxis directly to patients. Better control of both acute and delayed CINV would improve patient well-being as well as reduce the budgetary impact of CINV in Italy.
Ballatori
Enzo
E
Medical Statistics Unit, Department of Internal Medicine and Public Health, University of L'Aquila, Via Pillino, 2, 63030, Spinetoli (AP), Italy. e.ballatori@alice.it
Roila
Fausto
F
Ruggeri
Benedetta
B
Porrozzi
Stella
S
Iannopollo
Mauro
M
Soru
Giancarla
G
Cruciani
Giorgio
G
Daniele
Bruno
B
Locatelli
Maria Cristina
MC
Pellissier
James
J
Deuson
Robert
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics*; D002173:Cancer Care Facilities / Q000191:economics; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics*; D019370:Observation; D011446:Prospective Studies; D013222:State Medicine / Q000191:economics*; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics*
D000932:Antiemetics; D000970:Antineoplastic Agents