title: Resource utilization and costs associated with chemotherapy-induced nausea and vomiting (CINV) following highly or moderately emetogenic chemotherapy administered in the US outpatient hospital setting.
abstract: OBJECTIVE
  Chemotherapy-induced nausea and vomiting (CINV), common adverse events of chemotherapy, may be associated with considerable healthcare resource utilization. This study was conducted to describe CINV-associated healthcare visits and costs following a first cycle of highly or moderately emetogenic chemotherapy (HEC or MEC).
  
  
  METHODS
  This retrospective cohort study used the Premier Perspective™ Database to identify adult patients who received their first HEC or MEC and at least one antiemetic agent from 2003 to 2007 at US hospital-based outpatient facilities. Hospital visits with a CINV-related ICD-9 diagnosis were included from the chemotherapy administration date to 30 days later or 1 day before the second chemotherapy, whichever was first. CINV costs were hospital-reported costs.
  
  
  RESULTS
  Of 19,139 patients (HEC, 16%; MEC, 84%), mean (SD) age was 59 (14) years; 59% were female; 66% were white. CINV prophylaxis included 5-HT₃ antagonists (85%), dexamethasone (76%), and NK-1 antagonists (2%). Overall, 13.8% of patients had a CINV-associated visit (HEC, 18%; MEC, 13%): 0.2% for acute CINV (day of chemotherapy, excluding chemotherapy administration visit) and 13.7% for delayed CINV. CINV-associated visits included inpatient (IP, 64%), outpatient (OP, 26%), and emergency room (ER, 10%) visits. Mean (SD) costs of CINV visits were $5,299 ($6,639); for IP, $7,448 ($7,271); OP, $1,494 ($2,172); and ER, $918 ($1,071). Mean per-patient CINV-associated costs across all patients were $731 ($3,069). Sensitivity analysis excluding visits where CINV was a secondary diagnosis code resulted in a CINV incidence of 4.4%, a mean CINV visit cost of $4,043, and a mean per-patient CINV-associated cost across all patients of $176.
  
  
  CONCLUSIONS
  CINV visits in the first HEC or MEC cycle were common and costly, especially inpatient hospitalizations in the delayed phase. Strategies to reduce CINV in the delayed phase could reduce healthcare utilization and costs.
authors.affiliation: Global Outcomes Research, Oncology, Global Human Health, Merck & Co., Inc, One Merck Drive, WS2E-76, Whitehouse Station, NJ 08889, USA. thomas_burke2@merck.com
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
authors.forename: Tami
authors.initials: T
authors.lastname: Wisniewski
authors.forename: Frank R
authors.initials: FR
authors.lastname: Ernst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000191:economics; D015331:Cohort Studies; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy / Q000191:economics; D009369:Neoplasms / Q000188:drug therapy; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy / Q000191:economics; D055815:Young Adult
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents