Economic Burden of Chemo-Induced Nausea and Vomiting

A discussion on the economic burden of treating chemotherapy-induced nausea and vomiting.

Katherine Lin, PharmD, BCOP: Bhavesh, what have you seen to be the economic burden of CINV [chemotherapy-induced nausea and vomiting]?

Bhavesh Shah, RPh, BCOP: Obviously there is scant evidence on the economic burden. But if we look a few years back, in the Journal of Clinical Oncology, there was an article published that looked at data that were collected from a lot of the inpatient admissions that we’ve seen in the past 2 years. And they basically identified that it was about $15,000 per admission that we were seeing for CINV, which is still significant from before. I think that continues to go up based on the cost of care.

So there is definitely an economic burden, and if we can prevent it the right way the first time, it’s the best way to manage patients that way, especially if you’re in a risk-based environment. About 50% of our patient payments come from a risk-based environment. So we’re at risk for those patients. And it’s really important if we’re not actually managing them appropriately, there might be some up-front cost by using more expensive drugs. But then you actually have this downstream impact where you’re reducing the risk, where you’re actually paying yourself essentially.

So understanding that is really important. There is definitely an economic burden, and not only from the institution’s perspective but from the payer’s perspective and the patient’s perspective. Essentially, patients who actually aren’t able to keep up with their chemotherapy are going to have increase in symptoms, missing work, and a lot of impact in quality of life. So there are definitely a lot of other perspectives that we need to look at for CINV.

Katherine Lin, PharmD, BCOP: I agree. When you look at economic burden, it’s very easy to see that if patients are having uncontrolled CINV, they’re going to be utilizing increasing patient resources and health care resources, which really is driving up the overall cost of cancer care for us. The clinical consequence of uncontrolled CINV—dehydration, electrolyte imbalances, malnutrition, weight loss—is that those patients are going to be utilizing doctor’s offices more. They’re going to be in your clinic. They are going to be in the ED [emergency department] and may even require inpatient hospitalizations. And all those additional supportive resources that you’re going to need for those patients really does drive up the overall health care cost.

Bhavesh Shah, RPh, BCOP: Absolutely.

Katherine Lin, PharmD, BCOP: I like that you had said you know there’s an economic burden definitely for the patient. A lot of our patients, though, continue to be active in the workforce while we’re treating them. If they’re having uncontrolled CINV, they’re missing workdays, and that has a pretty significant impact on the patient. It impacts the employer, and then it’s impacting society as a whole too. So it really is, I agree with you, in our best interest that we’re controlling CINV.

Bhavesh Shah, RPh, BCOP: Yes. And I think a lot of institutions may also be participating in the Oncology Care Model, which also requires a lot of the care coordination—for you to make sure that these patients are coming for regular hydration, that somebody is assessing the electrolyte abnormalities, and that they have frequent visits with the provider to make sure they are continuing the cost essentially.

It’s great that there are models for that.