Costs of treatment with CHOP, COP/CVP and fludarabine in Canada, Germany and Italy

BACKGROUND AND OBJECTIVES: Few economic data exist on the treatment of indolent non-Hodgkin's lymphoma (NHL) and there are none in the published literature concerning relapsed disease. This international analysis (Canada, Germany, Italy) was established to estimate the overall direct cost of treating patients with relapsed indolent NHL and determine the main cost components of treatment. DESIGN AND METHODS: Telephone interviews were used to identify the most commonly used treatment regimens in each country. CHOP, CVP and fludarabine were chosen for economic analysis, which was based on retrospective data from 424 patients. RESULTS: Overall treatment costs for a course of six cycles varied more than 5-fold, from 3,445 to 17,940 Euros between regimens and countries. The treatment setting had a major impact on costs, with in-patient costs being up to three times greater than the equivalent out-patient values. Drug administration costs comprised 46-60% of the overall treatment costs in the in-patient setting. Adverse event management was the major cost component for out-patient CHOP and CVP therapy (52-75%), and a significant proportion (24-40%) of in-patient costs for these regimens. Drug acquisition accounted for less than half of treatment costs for most of the regimens analyzed. INTERPRETATION AND CONCLUSIONS: This study shows that not simply drug acquisition costs, but the costs of drug administration, particularly in the in-patient setting, and adverse event management are major contributors to the overall treatment costs for relapsed indolent NHL.