Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08854-8020, USA.
Res Social Adm Pharm. 2010 Sep;6(3):246-56. doi: 10.1016/j.sapharm.2009.07.004.
Although full costs (including direct and indirect costs) that incurred during the process of chemotherapy administration should be measured, many studies estimate only direct labor and medication costs associated with various chemotherapy delivery systems.
To estimate the total costs for dispensing and administration of fluorouracil when administered with leucovorin, by intravenous infusion or bolus, using a microcosting approach from the perspective of a provider or health system.
A time-and-motion study was used to measure the time spent by (1) pharmacy staff in the handling, admixture, and dispensing of fluorouracil and (2) patients in the clinic. The study was performed at The Cancer Institute of New Jersey for an 8-month period. Costs of dispensing and administering fluorouracil were calculated per patient visit on the basis of resources used in the processing of fluorouracil and time spent by pharmacy staff and patient. All costs were standardized to 2005 dollars.
A total of 275 observations were made, and 74 (26.9%) of these were associated with fluorouracil-based chemotherapy. Pharmacy staff spent an average of 11 minutes for bolus fluorouracil with leucovorin infusion (fluorouracil/LCV-IV) and 8 minutes for bolus fluorouracil with bolus leucovorin (fluorouracil/LCV-B). Patients who received fluorouracil/LCV-IV spent an average of 203 minutes in the clinic, whereas patients who received fluorouracil/LCV-B spent 110 minutes. The average cost of administering fluorouracil/LCV-IV was $933, which comprised drug costs ($279), dispensing costs ($189), and administration costs ($465). The average cost of fluorouracil/LCV-B was $474, which comprised drug costs ($65), dispensing costs ($141), and administration costs ($268).
This is the first study to formally demonstrate the high cost of administering the injectable form of fluorouracil chemotherapy with leucovorin, despite relatively low drug acquisition cost. Therefore, reimbursement rates for fluorouracil should be calculated in such a way that covers all costs, including overhead costs for the department.
虽然应测量化疗给药过程中产生的全部成本（包括直接成本和间接成本），但许多研究仅估计与各种化疗给药系统相关的直接人工和药物成本。
采用微观成本法从提供者或医疗体系的角度，估计氟尿嘧啶联合亚叶酸钙通过静脉输注或推注给药时的配置和给药总成本。
采用时间和动作研究来衡量（1）药剂师处理、混合和配置氟尿嘧啶的时间，以及（2）患者在诊所的时间。该研究在新泽西癌症研究所进行，为期 8 个月。根据氟尿嘧啶处理过程中使用的资源和药剂师及患者花费的时间，计算每位患者就诊时氟尿嘧啶的配置和给药成本。所有成本均按 2005 年美元标准化。
共观察到 275 次，其中 74 次（26.9%）与氟尿嘧啶为基础的化疗相关。氟尿嘧啶联合亚叶酸钙推注时（氟尿嘧啶/LCV-IV），药剂师平均花费 11 分钟，氟尿嘧啶联合亚叶酸钙推注时（氟尿嘧啶/LCV-B），药剂师平均花费 8 分钟。接受氟尿嘧啶/LCV-IV 的患者在诊所平均花费 203 分钟，而接受氟尿嘧啶/LCV-B 的患者平均花费 110 分钟。氟尿嘧啶/LCV-IV 的平均给药成本为 933 美元，其中包括药物成本（279 美元）、配置成本（189 美元）和给药成本（465 美元）。氟尿嘧啶/LCV-B 的平均成本为 474 美元，其中包括药物成本（65 美元）、配置成本（141 美元）和给药成本（268 美元）。
这是第一项正式证明尽管氟尿嘧啶药物购置成本相对较低，但联合亚叶酸钙给予氟尿嘧啶注射剂型的成本很高的研究。因此，氟尿嘧啶的报销费率应计算方式应涵盖所有成本，包括部门的间接成本。
