Costs of drug delivery for CHOP, COP/CVP, and fludarabine: An international assessment

Abstract

Objectives: The purpose of this analysis was to assess the real-life direct costs of drug delivery for frequently used chemotherapeutic regimens in patients with relapsed low-grade non-Hodgkin's lymphoma (NHL). Methods: This was a retrospective analysis of direct costs of drug delivery (acquisition plus administration) of relapsed low-grade NHL in 424 patients in Canada, Germany, and Italy. Results were expressed as an average treatment cost per patient for six cycles of chemotherapy. Exchange rates used were $1 (Canada) = € 0.672, 1 DM (Germany) = € 0.511, and 1 Lit (Italy) = € 0.000517. Results: Direct costs of drug delivery were greater for inpatients receiving fludarabine (Canada € 12,669; Italy € 13,027) than for CHOP (Canada € 7856; Germany € 7218; Italy € 4251) or COP/CVP (Canada € 7360; Germany € 8449). Treatment administration setting was a major cost driver with inpatient treatment up to 9-fold more expensive than the same regimen given to outpatients. Drug administration costs comprised the largest proportion of the total for each regimen in the inpatient setting (69-98%). Costs of drug delivery in the outpatient setting were 10% to 65% of those in the inpatient setting. Again, fludarabine was more expensive (Italy € 8493; Canada € 7269) than CHOP (Canada € 4403; Germany € 2150; Italy € 1264) and COP/CVP (Canada € 3009; Germany € 867). Administration costs were 2.5- to 15-fold higher for inpatients compared to outpatients. Conclusions: Costs of drug administration are a major driver for total direct treatment costs in the treatment of relapsed low-grade NHL and are at least as important as drug acquisition costs. Drug administration practices, in terms of inpatient or outpatient treatment, are a major factor in determining overall direct costs. Therapeutic strategies, which offer shortened treatment duration and/or a simple mode of administration, are likely to be economically attractive.