Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia.
Pharmacoeconomics. 2012 Dec 1;30(12):1173-86. doi: 10.2165/11597280-000000000-00000.
The increasing cost of chemotherapy is placing greater pressures on limited healthcare budgets. A potentially important, but often overlooked, aspect of chemotherapy is the cost associated with administration. This study aims to develop a better understanding of these costs, and in doing so, develop a model to estimate the comparative cost of administering alternative chemotherapy protocols for economic evaluation or local decision making.
We identified the potential tasks and choices related to administering intravenous chemotherapy, grouped tasks according to anticipated resource use, and allocated costs to each task using data from an evidence-based collection of cancer protocols or from primary data collection. The resources were costed from a healthcare system perspective using standard data sources within Australia. The model was applied to alternative protocols used in the treatment of three different cancers: locally advanced and metastatic non-small-cell lung cancer, adjuvant colorectal cancer and adjuvant breast cancer.
For the three cancer types examined, the cost of completed administration ranged from 1274 Australian dollars ($A) to $A3015 (year 2009 values) for 13 different protocols potentially used for the initial treatment of locally advanced and metastatic non-small-cell lung cancer; $A5175-8445 for seven protocols for adjuvant colorectal cancer treatment; and $A1494-4074 for seven protocols for adjuvant breast cancer treatment.
The results are of practical significance to those undertaking economic evaluations and to decision makers who use this information within the area of chemotherapy. The examples used suggest that administration costs per visit varied inversely with the number of visits. The results provide information where little has previously been available and may allow decisions about costs and resource allocation to be made with more certainty. Although our model uses costs from the public health system within an Australian state (New South Wales), it can be adapted for use in other jurisdictions.
化疗成本的不断增加给有限的医疗保健预算带来了更大的压力。化疗管理相关成本是一个具有重要意义但经常被忽视的方面。本研究旨在深入了解这些成本，并借此开发一个模型，以估算不同化疗方案的管理成本，从而用于经济评估或本地决策。
我们确定了与静脉化疗管理相关的潜在任务和选择，根据预期资源使用情况对任务进行分组，并使用基于证据的癌症方案集或原始数据收集来为每个任务分配成本。资源从澳大利亚医疗保健系统的角度进行成本核算，使用了标准数据源。该模型应用于三种不同癌症的替代方案：局部晚期和转移性非小细胞肺癌、辅助结直肠癌和辅助乳腺癌。
在所检查的三种癌症类型中，对于潜在用于局部晚期和转移性非小细胞肺癌初始治疗的 13 种不同方案，完成管理的成本范围为 1274 澳元（A 美元）至 3015 澳元（2009 年值）；对于 7 种辅助结直肠癌治疗方案，成本为 5175-8445 澳元；对于 7 种辅助乳腺癌治疗方案，成本为 1494-4074 澳元。
这些结果对于进行经济评估的人员和在化疗领域使用这些信息的决策者具有实际意义。所使用的示例表明，每次就诊的管理成本与就诊次数成反比。结果提供了以前很少有信息的地方的信息，可能使成本和资源分配决策更加确定。尽管我们的模型使用澳大利亚新南威尔士州公共卫生系统的成本，但它可以适用于其他司法管辖区。
