Aspetti economici nell’impiego della chemioterapia orale versus quella infusionale. Il ruolo di Vinorelbine orale nel carcinoma polmonare non a piccole cellule (Non Small Cell Lung Cancer – NSCLC)

Autori: Giorgio L. Colombo, Mauro Caruggi, Diego Cortinovis, Sergio Di Matteo, Luca Borlotti, Chiara Ottolini

Navelbine® (Vinorelbine) Oral is an orally administered formulation of chemotherapy (CT) recently introduced in Italy in the treatment of NSCLC (Non Small Cell Lung Cancer) and Metastatic Breast Cancer. The purpose of this study is to evaluate the economic consequences of the impact on pharmacy and nursing time and patient waiting of a switch from IV to oral CT in the treatment of NSCLC. Cost-minimisation analysis was developed in order to evaluate the times required to deliver IV vinorelbine and oral vinorelbine. The comparison was made in two settings with different patient pathways, in the Cancer Center Unit of Istituto Nazionale dei Tumori, Milan and Azienda Ospedaliera di Busto Arsizio, Varese. A stopwatch was used to time elements of essential processes (pharmacy preparation and chemotherapy administration) and patient waiting time for the delivery of a single dose of chemotherapy, in order to build an hypothetic diagnostic and therapeutic pathway and to describe different phases, times and costs for each formulation.

Administration of Vinorelbine Oral was less time consuming in both Cancer Centres. In the base case scenario, total costs were € 171,75 for Oral Vinorelbine (60 mg/m2) versus € 214,84 for IV Vinorelbine (25 mg/m2); for Oral Vinorelbine (80 mg/m2) versus IV Vinorelbine (30 mg/m2) costs were € 240,46 and € 232,82 respectively. Productivity loss and patient waiting time were key drivers to our cost minimisation analysis. Results were submitted to a Sensitivity Analysis. Delivery of oral CT is less resource intensive and time consuming than IV CT and reduces overall patient waiting in hospital. A switch from Vinorelbine IV to Oral formulation with home administration could increase the capacity of the Day-Hospital Unit, the number of prescriptions prepared by pharmacy and thereafter a reduction of the patient waiting list associated to a global cost reduction. The methodology provides a quantitative measure of comparative capacity that could be used as part of future health technology assessments.

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