Economic impact associated with the management of dermatologic adverse drug reactions (dADRs) induced by EGFR inhibitors (EGFRIs) in lung cancer

Abstract

19094 Background: Dermatologic adverse drug reactions including rash, paronychia, xerosis, alopecia and pruritus occur in up to 75% of non-small cell lung cancer (NSCLC) patients treated with EGFRIs. In addition to the impact on psychosocial and physical health, there are also financial implications. This study seeks to evaluate the costs associated with the management of cutaneous side effects caused by EGFRIs in patients with NSCLC referred to a dermatology-based program for the management of dADRs in oncology, the SERIES (Skin and Eye Reactions to Inhibitors of EGFR and kinaseS) clinic. Methods: Medical records for a subset of 10 NSCLC patients treated with the EGFRI erlotinib was identified. Unit costs for each resource were obtained from the Red Book for pharmaceuticals and Medicare Physician Fee Schedule for outpatient services. Average total cost for treatment (including drug regimen and administration-related costs) were computed based on average wholesale drug price and procedure code, respectively. Costs were also evaluated separately for: drug treatment, clinic visits and other services such as laboratory tests and biopsies. Results: All patients (100%) developed rash in addition to paronychia (40%), xerosis (80%), pruritus (50%) and alopecia (10%). Average number of visits and treatment period was 5 and 38.7 weeks respectively. Mean total cost for treatment (including drugs, clinic visit and other services) was $2,715.56 per patient. A mean of 12.6 prescriptions (range 4–39) were filled per patient for drugs treating dADRs, imposing a mean cost of $1,347.06 per the average patient. A mean of 6.3 administration-related services (clinic visits, lab tests, biopsies) per patient (range 1–17) accounted for an average cost of $1,368.50 to the average patient. Conclusions: This study substantiates that there is a considerable financial impact in the management of EGFRI-induced dADRs in NSCLC patients. Interventions that prophylactically address such frequently occurring cutaneous toxicities are critical for the minimization of dADR treatment-related costs. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen Inc, Bayer Pharmaceuticals, ImClone Systems