An assessment of chemotherapy-induced nausea and vomiting direct costs in three EU countries

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Background: Chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as one of the most distressing adverse effects among treated patients with cancer. Inadequately treated, CINV can lead to increased resource utilization and severely impair patients’ daily functioning and quality of life.

Direct costs include acquisition cost of antiemetic drugs and rescue medication, administration devices, add-on treatments, such as hydration, and additional patient care, that is, nursing and physician time, unscheduled office visits, emergency room admissions, and, in some cases, extended hospitalization or readmission. There are many reports on the cost-effectiveness of antiemetic drugs, but information on the total cost per patient associated with CINV is limited. The costs associated with severe CINV episodes are considered responsible for the most significant part of the expenditures.

Scope: The aim of this study was to investigate the management of CINV episodes in three European health-care environments and to estimate direct costs associated with severe CINV episodes.

Methods: An online survey addressed to Italian, German, and French oncologists and oncology nurses was performed. The survey included 41 questions about the management and the resource utilization for patients experiencing any CINV episode during the 6-month period preceding the survey. Furthermore, the cost associated with severe CINV episode management was estimated by adopting the National Health Service’s perspective.

Findings: A large proportion of patients receiving chemotherapy experienced a CINV episode (34.4% in Italy, 50.2% in France, and 40.4% in Germany); among those, 8.8% in Italy, 11.6% in France, and 19.2% in Germany experienced a severe CINV episode. Compared with Italy, Germany and France presented a greater hospitalization rate following an unplanned visit to the oncology ward or an emergency room access due to CINV. In Italy, the mean cost per patient with a severe CINV episode resulted in approximately €389, about half of the mean cost in France (€750) and a third of the mean cost in Germany (€1,017).

Conclusions: Severe CINV episodes requiring hospitalization, day hospital, or hospitalization extension involve a significant cost for the National Health Services; additional studies should be conducted in order to evaluate potential ways to offset these expenses.

Keywords: CINV, chemotherapy-induced nausea and vomiting, antiemetic, resource utilization, direct cost, Italy, France, Germany, CINV management.

Abbreviations: CINV, chemotherapy-induced nausea and vomiting; ER, emergency room; NHS, National Health Service; GP, general practitioner; TUC, Tariffa Unica Convenzionale; GHS, Globally Harmonized System.

Citation: Marco T, Vittoria P, Pierfrancesco R, Claudio R, Nazarena C. An assessment of chemotherapy-induced nausea and vomiting direct costs in three EU countries. Drugs in Context 2015; 4: 212285. DOI: 10.7573/dic.212285

Contributions: Claudio Ripellino and Nazarena Cataldo were responsible for survey design, data analyses, and writing of the manuscript. All authors read and approved the final manuscript.

Potential conflicts of interests and funding: The International Committee of Medical Journal Editors’ (ICMJE) Potential Conflicts of Interests forms for the authors are available for download at:

Funding declaration: This study was financially supported by an unrestricted grant from Helsinn Healthcare SA. Pierfrancesco Ruffo, Marco Turini, and Vittoria Piovesana are employees of Helsinn SA. Claudio Ripellino and Nazarena Cataldo are employees of IMS Health Information Solutions Medical Research srl and work for Novartis, Lundbeck, Bayer, Otsuka, Takeda, and Merck Serono. The authors have indicated that they have no other conflict of interest with regard to the content of this article.

Copyright: Copyright © 2015 Marco T, Vittoria P, Pierfrancesco R, Claudio R, Nazarena C. Distributed under the terms of the Creative Commons License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2015 Marco T, Vittoria P, Pierfrancesco R, Claudio R, Nazarena C. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 3.0.

Article URL: EU-countries

Correspondence: Nazarena Cataldo, IMS Health Information Solutions Medical Research srl, Viale E. Jenner, 53 – 20159 Milano – Italy.

Provenance: Submitted; externally peer reviewed

Submitted: 30 June 2015; Peer review comments to author: 9 July 2015; Published: 28 July 2015

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