Table 3. Base case costs and sources.
| Costs*(per month), Canadian $ | Base Case Value | Duration | Range Tested in Sensitivity Analyses | Distribution used in PSA± | Source | ||||
| Platinum-based chemotherapy | Chemotherapy acquisition and administration† | 635 | First 5 months | CCO [15] | |||||
| Chemotherapy regimen (cisplatin combined with flurouracil)‡ | 3,658 | First 5 months | LRCP [20] | ||||||
| Total | 4,293 | First 5 months | 2,000 – 5,000 | LogNormal (4,293; 3,850) | |||||
| Cetuximab± | Dosing during first month ∥ | 6,707 | First month on cetuximab | -0% – -100% | LogNormal (6,707; 6,300) | PMPRB [18] | |||
| Dosing during followed months∥ | 5,832 | Time on cetuximab therapy following first month | -0% – -100% | LogNormal (5,832; 5,285) | PMPRB [18] | ||||
| Infusion time during first month¶ | 518.2 | First month on cetuximab | −0% – −100% | LogNormal (518.2; 470) | [14] | ||||
| Infusion time followed months¶ | 414.5 | Time on cetuximab therapy following first month | −0% – −100% | LogNormal (414.5; 380) | [14] | ||||
| Pharmacy preparation § | 160 | Time on cetuximab therapy | −0% – −100% | LogNormal (160; 143) | [14] | ||||
| Cetuximab-related adverse events (per case) | Mild infusion-related and skin reactions | Consultation fee | 143.4 | One time | OHIP [49] | ||||
| Intravenous antihistamines with cetuximab infusion | 804 | Time on cetuximab therapy | 84–2,516 | LogNormal (804; 665) | OCCI [21] | ||||
| Combination of hydrocortisone & clindamycin, or minocycline | 56 | Time on cetuximab therapy | 56–88 | LogNormal (56; 52) | LRCP [20] | ||||
| Severe adverse events | Skin reactions | 2,912 | 335–14,110 | LogNormal (2,919; 2,670) | OCCI [21] | ||||
| Anorexia | 8,436 | 1,708–18,542 | LogNormal (8,436; 7,250) | OCCI [21] | |||||
| Hypomagnesemia | 5,516 | 1,658–10,996 | LogNormal (5,516; 4,720) | OCCI [21] | |||||
| Sepsis | 32,462 | 333–486,612 | LogNormal (32,462; 26,860) | OCCI [21] | |||||
| Hypotension | 3,234 | 486–15,141 | LogNormal (3,234; 2,780) | OCCI [21] | |||||
| Allergy or anaphylaxis | 3,764 | 126–21,332 | LogNormal (3,764; 3,420) | OCCI [21] | |||||
| Dyspnea | 3,991 | 148–33,249 | LogNormal (3,991; 3,590) | OCCI [21] | |||||
| Progression | Inpatient hospice care | 25,333 | Time with progression | 1,230–35,413 | LogNormal (25,333; 22,870) | OCCI [21] | |||
Costs include direct costs and indirect costs. Direct costs are costs that are directly related to the provision of care to the patient and include Nursing (incl. Operating Room, ICU), Diagnostic Imaging, Pharmacy and Labs. Indirect costs are overhead expense relating to the running of hospitals and include administration, finance, human resources, plant operations etc.
Lognormal(mean, median).
Chair time: Cancer Care Ontario Drug Formulary [15]; overhead costs: 2002 costs [50] ($ 35/h and $57.42/h respectively) inflated to 2011 using the bank of Canada inflation calculator [51].
Patients receive platinum-based chemotherapy including cisplatin (at a dose of 100 mg/m2 as a 1-hour intravenous infusion on day 1) and an infusion of fluorouracil (at a dose of 1000 mg/m2 per day for 4 days) every 3 weeks for a maximum of 6 cycles; assuming average m2 = 1.8; cisplatin = $448/100 mg; fluorouracil = $147.73 for 100 ml (500 mg vial).
Dosing: 400 mg/m2 initial followed by a weekly infusion of 250 mg/m2; assuming average m2 = 1.8; cetuximab = $3.24/mg;
Infusion time: initial dose infused over 120 min; weekly maintenance dose infused over 60 min; initial dose infusion time/cycle: $103.64/h×2 h = $207.28; maintenance dose infusion time: $103.64/h×1 h = $103.64.
Pharmacy preparation time required (e.g. Physician preparation, order processing): Pharmacy preparation time = $40/h×1 h = 40.
CCO = Cancer Care Ontario; LRCP = London Regional Cancer Program; PMPRB: Patented Medicines Prices Review Board; OHIP = Ontario Health Insurance Plan; OCCI: Ontario Case Costing Initiative.