Calhoun E A, Chang C H, Welshman E E, Fishman D A, Lurain J R, Bennett C L
The Institute for Health Services Research and Policy Studies, Department of Obstetrics and Gynecology, the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Oncologist. 2001;6(5):441-5. doi: 10.1634/theoncologist.6-5-441.
While chemotherapy-related toxicities affect cancer patients' activities of daily living and result in large expenditures of medical care for treatment, few studies have assessed the out-of-pocket and indirect costs incurred by patients who experience toxicity. The objective of this study was to evaluate the feasibility of obtaining detailed and comprehensive cost information from patients who experienced neutropenia, thrombocytopenia, or neurotoxicity during treatment.
Ovarian cancer patients who experienced chemotherapy-associated hematologic or neurologic toxicities were asked to record detailed information about hospitalization, laboratories, physician visits, phone calls, home visits, medication, medical devices, lost productivity, and caregivers. Resource estimates were converted into cost units, with direct medical cost estimates based on hospital cost-accounting data and indirect costs (i.e., productivity loss) on modified labor force, employment, and earnings data.
Direct medical costs were highest for neutropenia (mean of $7,546/episode), intermediate for thrombocytopenia (mean of $3,268/episode), and lowest for neurotoxicity (mean of $688/episode). Indirect costs relating to patient and caregiver work loss and payments for caregiver support were substantial, accounting for $4,220, $3,834, and $4,282 for patients who developed neurotoxicity, neutropenia, and thrombocytopenia, respectively. The total costs of chemotherapy-related neurotoxicity, neutropenia, and thrombocytopenia were $4,908, $11,830, and $7,550.
Our study has shown that, with the assistance of patients who are experiencing toxicity, estimation of the total costs of cancer-related toxicities is feasible. Indirect costs, while not included in prior estimates of the costs of toxicity studies, accounted for 34% to 86% of the total costs of cancer supportive care.
化疗相关毒性会影响癌症患者的日常生活活动，并导致治疗的医疗护理费用大幅增加，但很少有研究评估出现毒性反应的患者所产生的自付费用和间接费用。本研究的目的是评估从治疗期间经历中性粒细胞减少、血小板减少或神经毒性的患者那里获取详细和全面成本信息的可行性。
要求经历化疗相关血液学或神经学毒性的卵巢癌患者记录有关住院、实验室检查、医生诊疗、电话、家访、药物、医疗设备、生产力损失和护理人员的详细信息。资源估计数被转换为成本单位，直接医疗成本估计基于医院成本核算数据，间接成本（即生产力损失）基于经修改的劳动力、就业和收入数据。
中性粒细胞减少的直接医疗成本最高（平均每次发作7546美元），血小板减少的成本居中（平均每次发作3268美元），神经毒性的成本最低（平均每次发作688美元）。与患者和护理人员工作损失以及护理人员支持费用相关的间接成本相当可观，分别为出现神经毒性、中性粒细胞减少和血小板减少的患者4220美元、3834美元和4282美元。化疗相关神经毒性、中性粒细胞减少和血小板减少的总成本分别为4908美元、11830美元和7550美元。
我们的研究表明，在经历毒性反应的患者的协助下，估计癌症相关毒性的总成本是可行的。间接成本虽然未包含在先前毒性研究成本的估计中，但占癌症支持治疗总成本的34%至86%。
