Burke Thomas A, Wisniewski Tami, Ernst Frank R
Global Outcomes Research, Oncology, Global Human Health, Merck & Co., Inc, One Merck Drive, WS2E-76, Whitehouse Station, NJ 08889, USA.
Support Care Cancer. 2011 Jan;19(1):131-40. doi: 10.1007/s00520-009-0797-x. Epub 2010 Jan 26.
Chemotherapy-induced nausea and vomiting (CINV), common adverse events of chemotherapy, may be associated with considerable healthcare resource utilization. This study was conducted to describe CINV-associated healthcare visits and costs following a first cycle of highly or moderately emetogenic chemotherapy (HEC or MEC).
This retrospective cohort study used the Premier Perspective™ Database to identify adult patients who received their first HEC or MEC and at least one antiemetic agent from 2003 to 2007 at US hospital-based outpatient facilities. Hospital visits with a CINV-related ICD-9 diagnosis were included from the chemotherapy administration date to 30 days later or 1 day before the second chemotherapy, whichever was first. CINV costs were hospital-reported costs.
Of 19,139 patients (HEC, 16%; MEC, 84%), mean (SD) age was 59 (14) years; 59% were female; 66% were white. CINV prophylaxis included 5-HT₃ antagonists (85%), dexamethasone (76%), and NK-1 antagonists (2%). Overall, 13.8% of patients had a CINV-associated visit (HEC, 18%; MEC, 13%): 0.2% for acute CINV (day of chemotherapy, excluding chemotherapy administration visit) and 13.7% for delayed CINV. CINV-associated visits included inpatient (IP, 64%), outpatient (OP, 26%), and emergency room (ER, 10%) visits. Mean (SD) costs of CINV visits were $5,299 ($6,639); for IP, $7,448 ($7,271); OP, $1,494 ($2,172); and ER, $918 ($1,071). Mean per-patient CINV-associated costs across all patients were $731 ($3,069). Sensitivity analysis excluding visits where CINV was a secondary diagnosis code resulted in a CINV incidence of 4.4%, a mean CINV visit cost of $4,043, and a mean per-patient CINV-associated cost across all patients of $176.
CINV visits in the first HEC or MEC cycle were common and costly, especially inpatient hospitalizations in the delayed phase. Strategies to reduce CINV in the delayed phase could reduce healthcare utilization and costs.
化疗引起的恶心和呕吐（CINV）是化疗常见的不良事件，可能与大量医疗资源的使用相关。本研究旨在描述在接受高度或中度致吐性化疗（HEC或MEC）的第一个周期后与CINV相关的医疗就诊情况及费用。
这项回顾性队列研究使用Premier Perspective™数据库，以识别2003年至2007年在美国医院门诊设施接受首次HEC或MEC治疗且至少使用一种止吐药的成年患者。从化疗给药日期至30天后或第二次化疗前1天（以先到者为准），纳入具有CINV相关ICD-9诊断的医院就诊记录。CINV费用为医院报告的费用。
在19139例患者中（HEC占16%，MEC占84%），平均（标准差）年龄为59（14）岁；59%为女性；66%为白人。CINV预防用药包括5-羟色胺拮抗剂（85%）、地塞米松（76%）和NK-1拮抗剂（2%）。总体而言，13.8%的患者有与CINV相关的就诊（HEC组为18%，MEC组为13%）：急性CINV（化疗当天，不包括化疗给药就诊）为0.2%，延迟性CINV为13.7%。与CINV相关的就诊包括住院（IP，64%）、门诊（OP，26%）和急诊室（ER，10%）就诊。CINV就诊的平均（标准差）费用为5299美元（6639美元）；住院费用为7448美元（7271美元）；门诊费用为1494美元（2172美元）；急诊室费用为918美元（1071美元）。所有患者中与CINV相关的平均每人费用为731美元（3069美元）。排除CINV为次要诊断代码的就诊记录后的敏感性分析显示，CINV发生率为4.4%，CINV就诊平均费用为4043美元，所有患者中与CINV相关的平均每人费用为176美元。
在首次HEC或MEC周期中，与CINV相关的就诊很常见且费用高昂，尤其是延迟期的住院治疗。减少延迟期CINV的策略可降低医疗资源利用和费用。
