Patients with non-small cell lung cancer (NSCLC) who develop hypersensitivity reactions to first-line chemotherapy are faced with increasing clinical burden and rising costs, according to research presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting (March 27-30, 2017).
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Hypersensitivity reactions to a drug are defined as immune-mediated responses that are inappropriate or excessive in a sensitized patient. Five to ten percent of all adverse events qualify as hypersensitivity reactions. Although these type of reactions are not common after first-line chemotherapy treatment, a common belief is that hypersensitivity reactions could impose a significant clinical and economic burden to exhibiting patients.
Researchers from Celgene and the Stanford Cancer Center conducted a study to examine frequency, clinical burden, and economic burden of hypersensitivity reactions in patients with stage IV NSCLC after first-line chemotherapy. The retrospective cohort of 12,772 patients from 2012 to 2015 were required to have multiple claims with a secondary malignant neoplasm and with a lung cancer diagnosis.
Outcomes measured were median time to first hypersensitivity reaction, percentage of patients who modified treatment immediately following a reaction, severity of the reaction (mild or moderate requiring outpatient care, severe requiring emergency room visit or inpatient admission), health care utilization, and associated costs.
Among the total patient population, 666 (5.2%) were identified as having a hypersensitivity reaction. A total of 1269 reactions were identified, with some patients experiencing multiple reactions. Median time to first reaction was 22 days and 58% of patients modified their treatment immediately afterwards. Severe reactions occurred in 11% of patients and average length of stay was 6.6 days for those patients admitted into the hospital. Ninety-four percent of the reactions were treated in the outpatient setting.
Mean costs associated with a hypersensitivity reaction were $6118 in the outpatient settings, $4874 in the emergency room settings, and $28,993 in the inpatient settings. Mean costs associated with prescribed medications to treat such reactions were $1037, $989, and $3847, respectively.
Researchers concluded that hypersensitivity reactions result in significant clinical burden to patients with NSCLC after first-line chemotherapy, potentially leading to changes to treatment regimens and hospitalizations. Furthermore, such reactions were also found to contribute to significant economic burden for patients in this population, varying by care setting. – Zachary Bessette
