oncology patients. 4
Even when non-life-threatening,
side effects such as CINV have
negative consequences on a
patient’s quality of life, impairing
social, physical and emotional
functioning, and worsened health
outcomes due to dose reduction
or therapy discontinuation. 5,6
Besides the clinical impact, CINV
events impact the cost of cancer
care for both individuals and
healthcare systems, as they can
lead to increased hospitalisation,
more emergency room visits and
increased care. 5
Considering that such effects
of chemotherapy can be limited
with the appropriate antiemetic
treatment in up to 80% of patients, 7
the development of innovative
therapies and the study of
pharmacoeconomics related to
them is particularly crucial.
Health economics of CINV
There are different procedures to
classify costs in order to evaluate
the global economic burden
of nausea and vomiting due to
chemotherapy. The most common
categorisation organises costs as
direct and productivity losses. 8
Direct costs can be further
divided into healthcare and non-
healthcare. Healthcare direct costs
are those incurred in providing
a certain healthcare intervention.
The costs of antiemetic drugs,
hospitalisation and emergency
department visits are among the
44 | 2019 | hospitalpharmacyeurope.com
most studied direct healthcare
costs for CINV. The resources
consumed to deliver care (such
as the cost of telephone charges
for calls made because of CINV,
the cost of transportation to the
hospital or the cost for informal
care provided to patients by
family members) are referred to
as non-healthcare direct costs. 9
Productivity losses incur as a
result of loss of productivity due
to premature death, absenteeism
(work days lost to receive medical
care for CINV or for severe
pain) and presenteeism (lower
productivity due to experiencing
nausea or vomiting while at
work). 10 Productivity losses are
particularly relevant in the case
of CINV as they can account for
over 60% of total costs. 11 In addition
to direct costs and productivity
losses, patients suffer from a severe
deterioration of quality of life
(sometimes known as intangible
costs) because of pain associated
with certain side effects such as
CINV. 10 In health economics, these
intangible costs are extremely
difficult to evaluate in monetary
terms and for this reason they are
seldom included in cost-of-illness
studies but assessed through
generic or disease-specific quality
of life scales.
The categorisation by
Drummond et al, which organises
resources according to whether
they are used in the healthcare
sector, consumed in other