The Economic Burden of Chemotherapy-Induced Toxicity in Lymphoma and NSCLC Routine Hospital Care

The majority of chemotherapy (CT) patients (pts) receive care outside of clinical trial settings. In contrast little is known about the economic consequences of CT-induced toxicity in routine care. This was a prospective, multi-centre, observational, longitudinal cost-of-illness study. Lymphoma and non small cell lung cancer (NSCLC) pts were enrolled consecutively from 1/2005–12/2006 at the start of first or second line (immuno) CT treatment in 4 German hospitals. Patients receiving myeloablative CT with peripheral blood stem cells were excluded. Clinical data and resource use were collected from pre-planned chart reviews. German tariffs & prices in €2007 and hospital databases were used to allocate costs to health care resources. Toxicity related costs are presented from the hospital provider perspective. 273 pts undergoing 286 treatment courses with a total of 1004 CT-cycles were evaluable. 153 pts had lymphoma (47% of courses were CHOP-like) and 120 NSCLC (78% of courses were platinum-based). Mean age was 60.1 years (SD 13.0); age≥65 years 40%; female 36%; ECOG≥2 11%; tumour stage≥3 56%; history of co-morbidity 80%. The table shows a comparison of lymphoma and NSCLC patient characteristics. 208 of treatment courses (73%) were associated with at least one hospital stay (lymphoma 69%, NSCLC 78%). Mean±SD number of inpatient days was 13.1±17.7 (lymphoma 13.5±20.7, NSCLC 12.8±14.0). Mean (median) toxicity related costs amounted to€3,624 (€1,035) per treatment course with€3,366 (€1,406) for NSCLC and€3,838 (€684) for lymphoma. 8% of CT-courses (lymphoma n=12, NSCLC n= 11) were associated with costs ≥€10,000 and accounted for 50% of total expenses. In this high cost group mean toxicity associated costs nearly doubled for lymphoma pts (lymphoma€28,607, NSCLC€15,533). Hospital basic services and personnel represented 74% of total costs (lymphoma 70%, NSCLC 80%), followed by expenses for drugs (lymphoma 15%, NSCLC 9%). Our findings highlight that toxicity management in NSCLC and lymphoma pts induces significant resource use and associated costs. Cost drivers are hospitalization and drugs. Frequency distribution of costs is asymmetric with less than 10% of CT-courses contributing to half of total economic burden. Treatment courses with mean toxicity related costs of €10,000 or more are twice as expensive for lymphoma patients as for NSCLC.