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.

中文翻译：

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化疗管理成本：系统评价和荟萃分析

目的

癌症治疗是全球医疗保健成本的重要驱动因素，然而，用抗肿瘤药物治疗患者的经济影响尚不清楚。我们进行了一项系统评价和荟萃分析，以估计与在门诊环境中进行静脉化疗相关的直接成本。

方法

我们系统地搜索了 2010 年的四个数据库，以展示和提取每小时管理成本以及每个估算的相应组成部分。分别对加拿大和美国 (US) 研究进行了单独分析，以解决有关估计值异质性的先验假设。Drummond 检查表用于评估偏倚风险。使用具有四分位距的中位数对数据进行汇总，并确定了五个异常值；成本以 2019 美元表示。

结果

分析了 44 项研究，包括对 19 项美国研究和 7 项加拿大研究的子分析。26/44 研究具有中等质量。在评估管理成本的组成部分时，报告的医生成本最为频繁（24 项研究），其次是实验室测试（13）和间接成本（9）。估计中位数（不包括异常值）为 142 美元/小时（IQR = 103-166 美元）。美国的管理成本中位数为 149 美元/小时（IQR = 118-158 美元），加拿大为 128 美元/小时（IQR = 102-137 美元）。

结论

目前关于化疗管理成本的文献很少，现有的研究使用了拼凑的报告方法，这使得直接比较具有挑战性。我们的结果表明，全球范围内进行化疗的成本约为 125-150 美元/小时。该值取决于分析区域、成本子组件的包容性以及用于估算单价的方法，如此处所述。