Economic Burden of Hematologic Adverse Events in Cancer Patients Undergoing Chemotherapy: A Systematic Review.

OBJECTIVES: Hematologic adverse events such as neutropenia, thrombocytopenia, and anemia are commonly experienced by cancer patients receiving chemotherapy. These cytopenias are associated with increased morbidity and mortality, high healthcare costs, and decreases in quality of life. The objective of this study was to review the economic burden of these hematologic adverse events associated with chemotherapy in cancer patients.

METHODS: A systematic search of the English-language medical literature published between 1990 and 2006 was conducted. Online conference proceedings and a review of article bibliographies were included in the review. Articles selected included prospective or retrospective studies specifically designed to examine burden of illness, direct medical costs, indirect costs, or cost drivers associated with neutropenia, thrombocytopenia, and anemia in adult cancer patients treated with chemotherapy. All original costs were reported, with adjusted figures (to 2006 US dollars) presented in parentheses using the medical care component of the consumer price index from the US Bureau of Labor Statistics.

RESULTS: Of 160 studies initially identified, 64 met selection criteria and were reviewed in detail. The cost of neutropenia ranged from $1,893 (2006 US $2,632) per episode in the outpatient setting to $38,583 ($54,807) for a febrile neutropenia hospitalization. The cost of treating thrombocytopenia ranged from $1,037 ($1,395) to $7,550 ($9,336) per cycle or episode. Costs attributable to treating anemia ranged from $18,418 ($22,775) to $69,478 ($93,454) per year. Key cost drivers include hospitalization, drugs (e.g., granulocyte colony-stimulating factors and antibiotics), and diagnostic tests for neutropenia; hospitalization, major bleeding episodes, and platelet transfusions for thrombocytopenia; and inpatient and outpatient services, erythropoietic agents, and red blood cell transfusions for anemia. Another finding was that the costs of hematologic adverse events for patients with hematologic malignancies were up to twice that of patients with solid tumors.

CONCLUSIONS: Chemotherapy-related cytopenias result in a substantial economic burden on patients, payers, caregivers, and society in general. This burden is particularly high for patients with hematologic malignancies due to the underlying malignancy. Furthermore, AEs affect the ability to deliver planned treatments, resulting in potentially suboptimal clinical outcomes. An evaluation of both clinical outcomes of chemotherapy and economic consequences as a result of chemotherapy-induced toxicities is recommended in determining optimal treatments for patients with cancer.