title: Costs associated with intravenous chemotherapy administration in patients with small cell lung cancer: a retrospective claims database analysis.
abstract: OBJECTIVE
  With new oral chemotherapy drugs emerging, it is useful to understand the costs associated with traditional intravenous (IV) therapy. This study aims to assess costs associated with IV chemotherapy in patients with small cell lung cancer (SCLC) from the perspective of large employer-payers.
  
  
  METHODS
  Descriptive retrospective claims database analysis.
  
  
  METHODS
  Using medical claims data from 5.5 million beneficiaries between 01/01/1998 and 01/31/2006, we identified patients with lung cancer (ICD-9 codes 162.3-162.9, 176.4, or 197.0) who received IV chemotherapy. A case-finding SCLC algorithm was then applied which selected patients who were treated with chemotherapies commonly used in SCLC (cisplatin/etoposide, cisplatin/irinotecan, carboplatin/etoposide, topotecan, or cyclophosphamide/doxorubicin/vincristine) and then excluded those who had treatments or procedures indicative of non-small cell lung cancer (NSCLC) (positron emission tomography [PET] scan imaging, lung surgery, common NSCLC chemotherapies). Average total costs paid per day of IV chemotherapy administration were computed, along with separate costs for IV chemotherapy drugs, IV chemotherapy administration procedures, and other drugs and services received on IV visit days. Costs were also estimated per course of treatment based on the assumption of four chemotherapy cycles per course with three visits per cycle.
  
  
  RESULTS
  Among 8010 patients with a lung cancer diagnosis, 802 were identified as SCLC. In the SCLC subset, the average total daily cost was $787 ($9449/course), with $395 ($4742/course; 50.2%) attributable to IV chemotherapy drugs, $93 ($1112/course; 11.8%) to IV chemotherapy administration, and $300 ($3595/course; 38.0%) to other drugs and services.
  
  
  CONCLUSIONS
  The proposed algorithm identified about 10% of patients with lung cancer receiving IV chemotherapy as likely SCLC cases. Future studies should validate this algorithm with medical records data. IV chemotherapy administration and other visit-related drugs and services represented about half of the total cost per IV visit day, with the remainder attributable to direct costs for IV chemotherapy drugs.
authors.affiliation: Analysis Group, Inc., Boston, MA 02199, USA. mduh@analysisgroup.com
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reynolds Weiner
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.forename: Maureen
authors.initials: M
authors.lastname: Neary
authors.forename: Arthur T
authors.initials: AT
authors.lastname: Skarin
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000191:economics*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D016190:Carboplatin / Q000008:administration & dosage / Q000191:economics; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000191:economics*; D002945:Cisplatin / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics; D005047:Etoposide / Q000008:administration & dosage / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007262:Infusions, Intravenous / Q000191:economics; D007345:Insurance Claim Review; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019772:Topotecan / Q000008:administration & dosage / Q000191:economics; D014481:United States; D014750:Vincristine / Q000008:administration & dosage / Q000191:economics
chemical_list: D014750:Vincristine; D005047:Etoposide; D000077146:Irinotecan; D019772:Topotecan; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin; D002166:Camptothecin