Abstract
Background: Patients with multiple myeloma and other forms of cancer receiving pamidronate via intravenous (IV) infusion at the Hamilton Regional Cancer Centre in Hamilton, Ontario, Canada face 2 treatment options: they can have their entire treatment completed at the clinic using traditional IV therapy (e.g. IV bag and pole) or they can have the treatment initiated at the clinic and then return home to complete the treatment utilising a portable and disposable IV therapy device.
Objective: To perform a cost analysis of these 2 treatment options.
Perspective: Societal.
Methods and patients: Data on all patients with multiple myeloma who attended the Hamilton Regional Cancer Centre for pamidronate therapy from November 1, 1997 to October 31, 1998 were collected from clinic records. As almost all of these patients with multiple myeloma completed their IV therapy at home, comparison to clinic-based therapy was based on derived cost estimates. Cost data, where possible, were acquired from the Hamilton Regional Cancer Centre’s records. A sensitivity analysis was also conducted.
Results: In the base-case scenario for the study period, the incremental cost of the infusion device and training in Canadian dollars ($Can; 1998 values) for the 48 patients (299 cycles) who had their infusion initiated at the clinic but completed at home was $Can15.50/cycle ($Can4636 for the 299 cycles). If these 48 patients had had their entire infusion at the clinic, the incremental costs of overtime treatment, parking, clinic overheads and lost work or leisure time would have been $Can68.49/cycle ($Can20 477 for the 299 cycles). Therefore, shifting treatment from the clinic to the home resulted in net cost savings to society of $Can52.98/cycle ($Can15 841 for the 299 cycles).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Berenson J, Lichtenstein A, Porter L, et al. Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Myeloma aredia study group. N Engl J Med 1996; 334 (8): 488–93
Hillner BE, Ingle JN, Berenson JR, et al. American Society of Clinical Oncology guideline on the role of bisphosphonates in breast cancer. American Society of Clinical Oncology Bisphosphonates Expert Panel. J Clin Oncol 2000; 18 (6): 1378–91
Schleis TG, Tice AD. Selecting infusion devices for use in ambulatory care. Am J Health Syst Pharmaceut 1996 Apr 15; 53: 868–77
Veal DF, Altman CE, McKinnon BT, et al. Evaluation of flow rates for six disposable infusion devices. Am J Health Syst Pharmaceut 1995; 52 (5): 500–4
Capes DF, Asiimwe D. Performance of selected flow-restricting infusion devices. Am J Health Syst Pharmaceut 1999 Feb 15; 55 (4): 351–9
Hamid SK, Wong PK, Carmichael F, et al. A novel device for patient-controlled sedation: laboratory and clinical evaluation of the baxter intermate LV250 infusor and patient-control module. Anaesthesia 1996 Feb; 51 (2): 145–50
Otsuka A, Ono S, Hata M, et al. Outpatient chemotherapy with continuous intravenous infusion for patients with recurrent renal cell carcinoma or advanced prostate carcinoma. Gan To Kagaku Ryoho 1997 Dec; 24 (4): 485–9
Health Services Utilization and Research Commission (HSURC). The cost-effectiveness of home care: a rigorous review of the literature. Saskatchewan: HSURC, 1996
Poretz D, Woolard D, Eron L, et al. Outpatient use of ceftriaxone: a cost-benefit analysis. Am J Med 1984; 77 (4C): 77–83
Stiver H, Trosky S, Cote D, et al. Self-administration of intravenous antibiotics: an efficient, cost-effective home care program. CMAJ 1982; 127: 207–11
Culbertson V, Rhodes R, Hill E, et al. Impact of home infusion therapy on the Colorado Medicaid program budget. Am J Hosp Pharm 1988; 45: 1346–9
Eisenberg J, Kitz, D. Savings from outpatient antibiotic therapy for osteomyelitis: economic analysis of a therapeutic strategy. J Am Med Assoc 1986; 255 (12): 1584–8
Robson L, Bain C, Beck S, et al. Cost analysis of methlyprednisolone treatment of multiple sclerosis patients. Can J Neurol Sci 1998; 25: 222–9
Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA 1992; 268: 2420–5
Drummond MF, O’Brien BJ, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Toronto: Oxford University Press, 1997
Gold MR, Siegel JE, Russell LB, et al., editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
Posnett J, Jan S. Indirect cost in economic evaluation: the opportunity cost of unpaid inputs. Health Econ 1996; 5 (1): 13–23
Coukell A, Markham A. Pamidronate: a review of its use in the management of osteolytic bone metastases, tumour-induced hypercalcaemia and Paget’s disease of bone. Drugs Aging 1998; 12 (2): 149–68
van Holten-Verzantvoort A, Kroon H, Bijvoet O, et al. Palliative pamidronate treatment in patients with bone metastases from breast cancer. J Clin Oncol 1993; 11 (3): 491–8
Acknowledgements
The authors appreciate the co-operation and assistance of Hannah Farrell, National AMS Business Manager, Baxter Corporation. Dr. Coyte holds a Canadian Health Services Research Foundation/Canadian Institutes of Health Research Professorship in Healthcare Settings and Canadians. The opinions expressed are those of the authors and do not necessarily reflect the opinion of any funding agency or institution. The Home and Community Care Evaluation and Research Centre, University of Toronto, is partially supported by a contribution from Baxter Corporation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Coyte, P.C., Dobrow, M.J. & Broadfield, L. Incremental Cost Analysis of Ambulatory Clinic and Home-Based Intravenous Therapy for Patients with Multiple Myeloma. Pharmacoeconomics 19, 845–854 (2001). https://doi.org/10.2165/00019053-200119080-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-200119080-00006