The management of skin toxicity during erlotinib in advanced non-small cell lung cancer: how much does it cost?
BACKGROUND
The aim of this study is to estimate the costs for the foreseeable management of skin toxicity (papulo-pustular reactions) in patients treated with erlotinib for non-small cell lung cancer (NSCLC) in order to value the direct medical economical impact. No studies like the above have been published until now.


METHODS
We retrospectively analyzed all consecutive patients with NSCLC treated with erlotinib at Clinical Oncology Unit of University Hospital of Ferrara, Italy from June 2007 to May 2011. We evaluated severity and median duration of papulo-pustular reactions for each grade and we identified costs for the different therapeutic interventions.


RESULTS
We evaluated 25 patients. Median time follow-up was 18.65 months (range 5.69-88.36). Finally, follow-up 7 patients (28.0%) were alive with metastases and 18 patients (72.0%) were deceased. Nineteen patients (76.0%) developed papulo-pustular reactions: 2 patients (10.5%) mild rash, 11 patients (57.9%) moderate rash and 6 patients (31.6%) severe rash; no case of hospitalization was observed. Median duration of mild rash was 97 days (costs-range: 157.7-452.2 €), median duration of moderate rash was 89 days (costs-range: 438.7-1035.6 €) and median duration of severe rash was 34 days (costs-range: 460.3-1057.2 €).


CONCLUSIONS
Our experience, though the analysis of not selected case study, showed that management of skin toxicities related to erlotinib is not so expensive, especially for low grade; therefore, we also recommended to give particular attention to low grade of toxicities for reducing progression to high grade and consequent risk of hospitalization, which really impact on costs.
Palliative Care Unit, Mater Salutis Hospital, Legnago (VR), Italy. giuliani.jacopo@alice.it
Jacopo
J
Giuliani
Marina
M
Marzola
D000230:Adenocarcinoma / Q000188:drug therapy / Q000191:economics*; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000188:drug therapy / Q000191:economics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000191:economics; D003875:Drug Eruptions / Q000188:drug therapy / Q000191:economics / Q000209:etiology; D000069347:Erlotinib Hydrochloride; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011799:Quinazolines / Q000009:adverse effects*
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride