Out-of-pocket costs analysis of ifosfamide, epirubicin, and etoposide (IEV) and etoposide, solu-medrol-methylprednisolone, high-dose ara-C-cytarabine, and platinol-cisplatin (ESHAP) regimens in the patients with relapsed and refractory lymphoma in Iran
DOI:
https://doi.org/10.22122/cdj.v6i2.270Keywords:
Lymphoma, Cost, IEV Protocol, ESHAP ProtocolAbstract
BACKGROUND: This is an out-of-pocket costs analysis of ifosfamide, epirubicin, and etoposide (IEV) and etoposide, solu-medrol-methylprednisolone, high-dose ara-C-cytarabine, and platinol-cisplatin (ESHAP) drug regimens in treatment of lymphoma in Iran.
METHODS: This cross-sectional study was conducted in Shiraz City. Data were collected using a data-collection form. The social perspective was used to collect cost data. Three types of costs were measured, medical direct costs, non-medical direct costs, and indirect costs.
RESULTS: 65 patients were treated with these two methods; 27 patients were treated with IEV and 38 with ESHAP. Moreover, the mean direct cost in IEV and ESHAP regimens in 2014 were 1191.10 ± 610.74 and 1819.57 ± 789.73 United States dollars (USD), respectively. The difference was statistically significant (P < 0.001).
CONCLUSION: In this study, costs in the IEV regimen were significantly lower than the ESHAP regimen. This was particularly caused by an earlier discharge of patients under IEV regimen; since these patients experienced a trend toward less neutropenia and, hence, had a trend toward fewer hospitalization days, the related cost was 3451.76 USD with savings of 6479.61 USD compared with the ESHAP regimen. Overall, most of patient’s income was spent on out-of-pocket costs for all expenditures incurred because of lymphoma.
References
World Health Organization. World cancer report 2014 [Online]. [cited 2014]; Available from: URL: http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=76&codcch=31
American Cancer Society. Cancer facts & figures 2018 [Online]. [cited 2018]; Available from: URL: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html
American Cancer Society. Cancer facts & figures 2014 [Online]. [cited 2014]; Available from: URL: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2014.html
Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst 2011; 103(2): 117-28.
Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 1993; 328(14): 1002-6.
Oza AM, Ganesan TS, Leahy M, Gregory W, Lim J, Dadiotis L, et al. Patterns of survival in patients with Hodgkin's disease: Long follow up in a single centre. Ann Oncol 1993; 4(5): 385-92.
Choi CW, Paek CW, Seo JH, Kim BS, Shin SW, Kim YH, et al. ESHAP salvage therapy for relapsed or refractory non-Hodgkin's lymphoma. J Korean Med Sci 2002; 17(5): 621-4.
Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: Results of a BNLI randomised trial. Lancet 1993; 341(8852): 1051-4.
Beard SM, Lorigan PC, Sampson FC. The cost-effectiveness of high dose chemotherapy in the treatment of relapsed Hodgkin's disease and non-Hodgkin's lymphoma. Br J Cancer 2000; 82(1): 81-4.
Velasquez WS, McLaughlin P, Tucker S, Hagemeister FB, Swan F, Rodriguez MA, et al.
ESHAP--an effective chemotherapy regimen in refractory and relapsing lymphoma: A 4-year follow-up study. J Clin Oncol 1994; 12(6): 1169-76.
Zinzani PL, Tani M, Molinari AL, Stefoni V, Zuffa E, Alinari L, et al. Ifosfamide, epirubicin and etoposide regimen as salvage and mobilizing therapy for relapsed/refractory lymphoma patients. Haematologica 2002; 87(8): 816-21.
Schulz R, Williamson GM, Knapp JE, Bookwala J, Lave J, Fello M. The psychological, social, and economic impact of illness among patients with recurrent cancer. J Psychosoc Oncol 1995; 13(3): 21-45.
Mousavi SH. Executive guideline for registering and reporting cancer cases. Tehran, Iran: Cancer Office and the Research fellowship of Cancer Research Center of Cancer Institute; 2007. [In Persian].
Park B, Youn S, Yi KK, Lee SY, Lee JS, Chung S. The Prevalence of Depression among Patients with the Top Ten Most Common Cancers in South Korea. Psychiatry Investig 2017; 14(5): 618-625.
Gruschkus SK, Lairson D, Dunn JK, Risser J, Du XL. Cost-effectiveness of white blood cell growth factor use among a large nationwide cohort of elderly non-Hodgkin's lymphoma patients treated with chemotherapy. Value Health 2011; 14(2): 253-62.
Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106(10): 2258-66.
Lee S, Knox A, Zeng IS, Coomarasamy C, Blacklock H, Issa S. Primary prophylaxis with granulocyte colony-stimulating factor (GCSF) reduces the incidence of febrile neutropenia in patients with non-Hodgkin lymphoma (NHL) receiving CHOP chemotherapy treatment without adversely affecting their quality of life: Cost-benefit and quality of life analysis. Support Care Cancer 2013; 21(3): 841-6.
Norum J, Angelsen V, Wist E, Olsen JA. Treatment costs in Hodgkin's disease: A cost-utility analysis. Eur J Cancer 1996; 32A(9): 1510-7.
Ray JA, Carr E, Lewis G, Marcus R. An evaluation of the cost-effectiveness of rituximab in combination with chemotherapy for the first-line treatment of follicular non-Hodgkin's lymphoma in the UK. Value Health 2010; 13(4): 346-57.
Sweetenham J, Hieke K, Kerrigan M, Howard P, Smartt PF, McIntyre AM, et al. Cost-minimization analysis of CHOP, fludarabine and rituximab for the treatment of relapsed indolent B-cell non-Hodgkin's lymphoma in the U.K. Br J Haematol 1999; 106(1): 47-54.