Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine

The costs of chemotherapy toxicity were analyzed in patients with relapsed low-grade non-Hodgkin's lymphoma (NHL). A total of 91 specialists regularly treating NHL were interviewed by telephone to identify the most commonly used treatment regimens. Retrospective case record forms providing data on 424 patients with relapsed low-grade NHL were used to assess adverse event (AE) frequency and management. Data on one cycle of treatment was collected for each patient, and unit costs were assessed and extrapolated for six cycles to estimate AE costs for an average course of treatment. Average AE management costs were evaluated by country and treatment regimen. Toxicity costs were substantial for the most commonly used chemotherapy regimens, namely CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), COP/CVP (cyclophosphamide, vincristine, prednisone), and fludarabine therapies. In Canada CHOP-associated AEs costs (EUR 5.036 per patient) were more than twofold greater than drug acquisition costs, and cost more than AEs associated with COP/CVP (EUR 3.252) or fludarabine (EUR 1.273). In Germany CHOP-associated AE costs (EUR 2.515) were comparable to to those associated with COP/CVP (EUR 2.658). In Italy CHOP-associated AE costs (EUR 2.179) were considerably less than those associated with fludarabine treatment (EUR 4.908). Neutropenia and fever/infection AEs were the most common and more expensive to treat than nausea and vomiting, anaemia, thrombocytopenia, or other AEs in all three countries. This study shows that management of neutropenia and fever/infection are the most expensive AE costs associated with conventional chemotherapeutic treatment of relapsed low-grade NHL. AE management costs are substantial and are likely to be an important cost driver in all countries.