Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.
Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 011, Toronto, ON, M4N 3M5, Canada.
Eur J Health Econ. 2021 Jun;22(4):605-620. doi: 10.1007/s10198-021-01278-0. Epub 2021 Mar 9.
Cancer treatment is a significant driver of healthcare costs worldwide, however, the economic impact of treating patients with anti-neoplastic agents is poorly elucidated. We conducted a systematic review and meta-analysis to estimate the direct costs associated with administering intravenous chemotherapy in an outpatient setting.
We systematically searched four databases from 2010 to present and extracted hourly administration costs and the respective components of each estimate. Separate analyses were conducted of Canadian and United States (US) studies, respectively, to address a priori hypotheses regarding heterogeneity amongst estimates. The Drummond checklist was used to assess risk-of-bias. Data were summarized using medians with interquartile ranges and five outliers were identified; costs were presented in 2019 USD.
Forty-four studies were analyzed, including sub-analyses of 19 US and seven Canadian studies. 26/44 studies were of moderate-high quality. When components of administration cost were evaluated, physician costs were reported most frequently (24 studies), followed by lab tests (13) and overhead costs (9). The median estimate (excluding outliers) was $142/hour (IQR = $103-166). The median administration cost in the US was $149/hour (IQR = $118-158), and was $128/hour (IQR = $102-137) in Canada.
There is currently a paucity of literature addressing the costs of chemotherapy administration, and existing studies utilize a patchwork of reporting methodologies which renders direct comparison challenging. Our results demonstrate that the cost of administering chemotherapy is approximately $125-150/hour, globally. This value is dependent upon the region of analysis, inclusiveness of cost subcomponents as well as the methodology used to estimate unit prices, as described here.
癌症治疗是全球医疗保健成本的主要驱动因素，然而，抗肿瘤药物治疗患者的经济影响仍不清楚。我们进行了系统评价和荟萃分析，以估计在门诊环境下给予静脉化疗的直接成本。
我们系统地检索了 2010 年至现在的四个数据库，并提取了每小时管理成本和每个估算的相应组成部分。分别对加拿大和美国的研究进行了单独的分析，以解决关于估计值之间异质性的先验假设。使用 Drummond 清单评估风险偏差。数据以中位数和四分位距（IQR）表示，并确定了五个异常值；成本以 2019 年美元表示。
分析了 44 项研究，包括 19 项美国和 7 项加拿大研究的子分析。26/44 项研究为中高度质量。在评估管理成本组成部分时，报告最多的是医生成本（24 项研究），其次是实验室检查（13 项）和间接成本（9 项）。中位数估计值（不包括异常值）为 142 美元/小时（IQR=103-166）。美国的中位数管理成本为 149 美元/小时（IQR=118-158），加拿大为 128 美元/小时（IQR=102-137）。
目前关于化疗管理成本的文献很少，现有的研究使用了一系列报告方法，使得直接比较具有挑战性。我们的结果表明，全球范围内，化疗管理的成本约为 125-150 美元/小时。该值取决于分析区域、成本子成分的包容性以及此处描述的估计单位价格的方法。
