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The cost of chemotherapy administration: a systematic review and meta-analysis

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Abstract

Purpose

Cancer treatment is a significant driver of healthcare costs worldwide, however, the economic impact of treating patients with anti-neoplastic agents is poorly elucidated. We conducted a systematic review and meta-analysis to estimate the direct costs associated with administering intravenous chemotherapy in an outpatient setting.

Methods

We systematically searched four databases from 2010 to present and extracted hourly administration costs and the respective components of each estimate. Separate analyses were conducted of Canadian and United States (US) studies, respectively, to address a priori hypotheses regarding heterogeneity amongst estimates. The Drummond checklist was used to assess risk-of-bias. Data were summarized using medians with interquartile ranges and five outliers were identified; costs were presented in 2019 USD.

Results

Forty-four studies were analyzed, including sub-analyses of 19 US and seven Canadian studies. 26/44 studies were of moderate-high quality. When components of administration cost were evaluated, physician costs were reported most frequently (24 studies), followed by lab tests (13) and overhead costs (9). The median estimate (excluding outliers) was $142/hour (IQR = $103–166). The median administration cost in the US was $149/hour (IQR = $118–158), and was $128/hour (IQR = $102–137) in Canada.

Conclusions

There is currently a paucity of literature addressing the costs of chemotherapy administration, and existing studies utilize a patchwork of reporting methodologies which renders direct comparison challenging. Our results demonstrate that the cost of administering chemotherapy is approximately $125–150/hour, globally. This value is dependent upon the region of analysis, inclusiveness of cost subcomponents as well as the methodology used to estimate unit prices, as described here.

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Funding

This study was supported by the Sherif and Hanna Chair in Surgical Oncology Research.

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Authors and Affiliations

  1. Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada

    Gursharan K. Sohi, Victoria Delibasic, Laura E. Davis, Elmira Amirazodi & Rajan Shah

  2. Division of General Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 011, Toronto, ON, M4N 3M5, Canada

    Jordan Levy, Julie Hallet & Natalie G. Coburn

  3. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Alyson L. Mahar

  4. Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Craig C. Earle

  5. ICES, Toronto, ON, Canada

    Ahmed Hammad

  6. Division of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Nicole Mittmann

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  1. Gursharan K. Sohi
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Correspondence to Natalie G. Coburn.

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NGC receives salary support from Cancer Care Ontario as the Clinical Lead of patient-reported outcomes and symptom management.

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Sohi, G.K., Levy, J., Delibasic, V. et al. The cost of chemotherapy administration: a systematic review and meta-analysis. Eur J Health Econ 22, 605–620 (2021). https://doi.org/10.1007/s10198-021-01278-0

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