Clinical and economic burden of chemotherapy-induced nausea and vomiting among patients with cancer in a hospital outpatient setting in the United States

Abstract

Objective:

This study evaluated the overall burden of illness of chemotherapy-induced nausea and vomiting (CINV) and associated all-cause costs from a hospital’s perspective (costs to the hospital) in patients with cancer treated with chemotherapy (CT) in the US hospital outpatient setting.

Methods:

Patients with a cancer diagnosis aged ≥18 years initiating CT in a hospital outpatient setting for the first time between April 1 2007 and March 31 2009 were extracted from the Premier Perspective Database. Patients were followed through eight CT cycles or 6 months post-index date, whichever occurred first. Within each CT cycle, the follow-up time for CINV event estimation was from day 1 (except rescue medication use that was identified from day 2) to cycle end. A multivariate regression model was developed to predict the CINV event rate per CT cycle in the study follow-up period. Associated total all-cause costs of managing CINV from a hospital’s perspective were analyzed descriptively. Event rate and associated costs were estimated in the entire hospital setting (outpatient, inpatient, and emergency room). All-cause costs included inpatient, hospital outpatient, and ER visit costs (identified through a primary or secondary diagnosis code for nausea, vomiting, and/or volume depletion) and pharmacy cost (rescue medications for CINV treatment). All physician costs and non CINV-related treatment (pharmacy) costs were excluded from the analyses.

Results:

Among 11,495 study patients, 8,806 patients (76.6%) received prophylaxis for all cycles in the follow-up period. The overall base population had an average age of 63.3 years, was 51.0% female, and 72.7% White. The distribution of emetogenicity for cycle 1 CT cycle was 26.0% HEC, 46.1% MEC, and 26.4% LEC/MinEC combined. In the follow-up period, a total of 47,988 CINV events with an associated total all-cause treatment cost of $89 million were observed. Average daily treatment cost for all care settings was $1854.7. The regression model predicted a 20% CINV event rate per CT cycle in the follow-up period. Study limitations include potential lack of generalizibility, absence of data on certain confounders including alcohol consumption and prior history of motion sickness, lack of a control analysis group to estimate incremental use of resource utilization and associated costs, and a potential for cost under-estimation.

Conclusion:

In the current study analysis, a 20% CINV event rate per CT cycle per patient was predicted with an associated all-cause average daily total cost of approximately $1850. Further studies on early and appropriate antiemetic prophylaxis on CINV rates and economic outcomes are warranted.

Key words::

• Antiemetic therapy
• Burden
• Cancer emesis
• Chemotherapy
• Cost
• Hospital outpatient setting
• Nausea
• Vomiting

Transparency

Declaration of financial/other relationships

C.C. is an employee of Premier, Inc, which received funding to conduct the study.

J.G. is an employee of Premier, Inc, which received funding to conduct the study.

S.B. is an employee of the Health Outcomes Department at Eisai, Inc.

D.B. is an employee of the Health Outcomes Department at Eisai, Inc.

This study was funded by a grant from Eisai, Inc.

Acknowledgments

Editorial support for the preparation of this manuscript was provided by Michelle A. Adams of Write All, Inc.

This article was previously presented as: Balu S, Craver C, Gayle J, Buchner D. Clinical and economic burden of chemotherapy induced nausea and vomiting among patients with cancer in a hospital outpatient setting in the United States at the 2010 American Society of Health-System Pharmacists (ASHP) Mid-Year Clinical Meeting; December 5–9, 2010; Anaheim, CA, USA