Cost of adverse events during treatment with everolimus plus exemestane or single-agent chemotherapy in patients with advanced breast cancer in Western Europe

Figures & data

Table 1. Cost and rates of adverse events.

Grade 3/4 adverse event	Cost per event (2012 EUR)^a	Adverse event rates
		EVE + EXE^b	Capecitabine^c	Docetaxel^d	Doxorubicin^e
Abdominal pain38	€157	0.2%	3.4%	1.4%	0.4%
Alanine aminotransferase increased45	€271	3.3%	0.0%	0.0%	0.0%
Alopecia39	€194	0.0%	0.0%	4.2%	0.0%
Anemia40	€2024	7.5%	3.4%	4.0%	6.8%
Anorexia40	€701	0.0%	2.5%	0.5%	0.1%
Aspartate aminotransferase increased45	€297	3.5%	0.0%	0.0%	0.0%
Asthenia40	€689	2.1%	0.0%	8.6%	3.4%
Dehydration41	€2417	0.4%	4.2%	0.3%	0.0%
Diarrhea40	€1735	2.5%	14.7%	6.0%	1.2%
Dyspnea40	€495	5.2%	1.0%	1.4%	0.0%
Fatigue40	€689	4.6%	7.8%	4.2%	0.6%
Gamma-glutamyltransferase increased45	€241	6.2%	0.0%	0.0%	0.0%
Hand-and-foot syndrome40	€1401	0.0%	9.3%	0.4%	0.0%
Hyperbilirubinemia45	€241	0.2%	9.3%	1.6%	0.0%
Hyperglycemia42	€287	5.6%	0.0%	0.0%	0.0%
Hypokalemia45	€241	3.3%	3.4%	0.0%	0.0%
Infection43	€1851	6.6%	0.0%	1.8%	2.6%
Leukopenia40	€1730	0.6%	0.0%	31.2%	22.1%
Lymphocytopenia40	€1730	1.5%	49.8%	33.7%	0.0%
Neutropenia40	€1385	2.3%	3.4%	59.3%	24.4%
Pneumonitis44	€2102	3.3%	0.0%	0.0%	0.0%
Stomatitis40	€763	7.9%	5.9%	3.4%	6.5%
Thrombocytopenia40	€1911	2.9%	0.0%	1.5%	4.0%
Vomiting and nausea40	€1202	1.6%	8.3%	4.0%	12.3%

^aCosts were inflated to 2012 EUR using the Harmonized Index of Consumer Prices (HICP) provided by the European Central Bank (ECB)28 for most European countries, the Consumer Price Index for UK29, and the Consumer Price Index for the US30. Western Europe costs were averaged across countries based on data availability. Countries considered include: Belgium, France, Germany, the UK, Italy, Spain, Sweden, and Switzerland.

^bRates of adverse events for Everolimus + Exemestane are from Novartis’ data-on-file based on the BOLERO-2 trial (data cut-off at December 15, 2011).

^cCapecitabine AE rates come from a weighted average of rates reported in the Phase II stage IV breast cancer Capecitabine monotherapy trial (see US label32) and the open label sequential dosing trial33.

^dRates of adverse events for Docetaxel are a weighted average of rates reported in the (i) Phase III Clinical Trial Capecitabine + Docetaxel combination therapy vs Docetaxel monotherapy (see US label for Capecitabine32), (ii) Phase III Clinical Trial Docetaxel vs Doxorubicin34, and (iii) Phase III Clinical AVADO35.

^eRates of adverse events for Doxorubicin are a weighted average of rates reported in the (i) Phase III Clinical Trial Doxorubicin vs Caelyx/Doxil36, (ii) Phase III Clinical Trial Docetaxel vs Doxorubicin34, and (iii) Phase III Intergroup Trial E119337.

Figure 1. Cost of managing adverse events—per patient in euros.

Table 2. Most costly adverse event on a per patient basis, by treatment.

No.	EVE + EXE		Capecitabine		Docetaxel		Doxorubicin
	AE	Costs	AE	Costs	AE	Costs	AE	Costs
1	Anemia	€152	Lymphocytopenia	€861	Neutropenia	€821	Leukopenia	€382
2	Infection	€122	Diarrhea	€256	Lymphocytopenia	€583	Neutropenia	€337
3	Pneumonitis	€69	Hand-and-food syndrome	€130	Leukopenia	€540	Vomiting and nausea	€148
4	Stomatitis	€60	Dehydration	€102	Diarrhea	€104	Anemia	€139
5	Thrombocytopenia	€55	Vomiting and nausea	€100	Anemia	€81	Thrombocytopenia	€77
6	Diarrhea	€43	Anemia	€68	Asthenia	€59	Stomatitis	€50
7	Neutropenia	€32	Fatigue	€54	Vomiting and Nausea	€49	Infection	€48
8	Fatigue	€32	Neutropenia	€47	Infection	€33	Asthenia	€24
9	Lymphocytopenia	€26	Stomatitis	€45	Fatigue	€29	Diarrhea	€21
10	Dyspnea	€26	Hyperbilirubinemia	€22	Thrombocytopenia	€29	Fatigue	€4
11	Vomiting and nausea	€19	Anorexia	€18	Stomatitis	€26	Anorexia	€1
12	Hyperglycemia	€16	Hypokalemia	€8	Alopecia	€8	Abdominal pain	€1
13	Gamma-glutamyltransferase increased	€15	Abdominal pain	€5	Dehydration	€7	Alanine aminotransferase increased	€0
14	Asthenia	€14	Dyspnea	€5	Dyspnea	€7	Alopecia	€0
15	Aspartate aminotransferase increased	€10	Alanine aminotransferase increased	€0	Hand-and-foot syndrome	€6	Aspartate aminotransferase increased	€0
16	Leukopenia	€10	Alopecia	€0	Hyperbilirubinemia	€4	Dehydration	€0
17	Dehydration	€10	Aspartate aminotransferase increased	€0	Anorexia	€3	Dyspnea	€0
18	Alanine aminotransferase increased	€9	Asthenia	€0	Abdominal pain	€2	Gamma-glutamyltransferase increased	€0
19	Hypokalemia	€8	Gamma-glutamyltransferase increased	€0	Alanine aminotransferase increased	€0	Hand-and-foot syndrome	€0
20	Hyperbilirubinemia	€0	Hyperglycemia	€0	Aspartate aminotransferase increased	€0	Hyperbilirubinemia	€0
21	Abdominal pain	€0	Infection	€0	Gamma-glutamyltransferase increased	€0	Hyperglycemia	€0
22	Alopecia	€0	Leukopenia	€0	Hyperglycemia	€0	Hypokalemia	€0
23	Anorexia	€0	Pneumonitis	€0	Hypokalemia	€0	Lymphocytopenia	€0
24	Hand-and-foot syndrome	€0	Thrombocytopenia	€0	Pneumonitis	€0	Pneumonitis	€0

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