title: Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients.
abstract: BACKGROUND
  Multidrug chemotherapy (CT) is still associated with relevant side-effects. We assessed, under current practice patterns, frequency and severity of CT-induced toxicity and its economic consequences.
  
  
  METHODS
  Prospective, multicentre, longitudinal, observational cohort study with lymphoproliferative disorder (LPD) and non-small-cell lung cancer (NSCLC) patients, receiving first- or second-line (immuno-) CT (excluding myeloablative CT). Data were collected from patient interviews and preplanned chart reviews. Costs in 2007 euros are presented from the provider perspective.
  
  
  RESULTS
  Two hundred and seventy-three patients (n = 153 LPD; n = 120 NSCLC) undergoing a total of 1004 CT cycles were assessable (age ≥65 years, 40%; female, 36%; Eastern Cooperative Oncology Group performance status ≥2, 11%; tumour stage ≥III, 56%; history of comorbidity, 80%). Fifty percent of cycles were associated with grade 3/4 toxicity and 37% (n = 371) with at least one hospital stay (outpatient/day care n = 154; intensive care n = 19). Mean (median) toxicity-related costs amounted to €1032 (€86) per cycle. Costs rose exponentially with the number of grade 3/4 adverse drug reactions (ADRs) and were highest in cycles affected by more than four ADRs, €10 881 (€5455); in cycles with intensive care, €14 121 (€8833); and in cycles affected by grade 3/4 infections and febrile neutropenia/leukopenia, €7093 (€4531) and €5170 (€2899), respectively. Five percent of CT cycles accounted for 56% of total expenses.
  
  
  CONCLUSIONS
  Individualised supportive care strategies are needed. Future research should focus on identifying toxicity clusters and patient characteristics predictive for high costs.
authors.affiliation: Department of Hospital Pharmacy, Technische Universität München, Munich, Germany.
authors.forename: B J
authors.initials: BJ
authors.lastname: Paessens
authors.forename: C
authors.initials: C
authors.lastname: von Schilling
authors.forename: K
authors.initials: K
authors.lastname: Berger
authors.forename: M
authors.initials: M
authors.lastname: Shlaen
authors.forename: C
authors.initials: C
authors.lastname: Müller-Thomas
authors.forename: R
authors.initials: R
authors.lastname: Bernard
authors.forename: C
authors.initials: C
authors.lastname: Peschel
authors.forename: A
authors.initials: A
authors.lastname: Ihbe-Heffinger
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics*; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies