In the high-stakes landscape of cancer treatment where healthcare professionals rely on cost-effectiveness analyses to guide decisions adverse event costs may be throwing off the equation. A new systematic review reveals that many oncology drug evaluations dramatically undervalue the true financial burden of treatment-related side effects.
In a comprehensive review of 102 US payer-perspective cost-effectiveness analyses published between 2003 and 2023 alongside 11 claims-based studies including over 34,000 patients researchers found that estimated adverse event costs in CEAs were consistently lower than actual values. Median discrepancies were significant both in proportion of total medical costs—9.73% lower—and in absolute dollar amounts—$17,201 less than real-world figures.
These gaps matter. When researchers substituted actual adverse event costs into published CEAs, the incremental cost-effectiveness ratio (ICER) shifted by an average of $42,656 per quality-adjusted life year. In nearly half the cases reviewed, this recalculation changed whether a drug was deemed cost-effective under widely used thresholds of $100,000 and $150,000 per QALY.
The review also flagged major inconsistencies and omissions in how adverse events are represented in oncology CEAs. Nearly 41% of studies failed to specify which adverse events were considered. Of the rest, 79% excluded lower-grade (1 and 2) events while 85% ignored postprogression costs. Only 13% accounted for dose reductions or treatment interruptions, and over 80% assumed adverse events occurred only in the first cycle of treatment.
This widespread underestimation raises concerns about the reliability of economic models that inform oncology practice and policy. Inaccurate AE accounting not only affects cost calculations but risks skewing treatment comparisons and reimbursement decisions.
The findings underscore the need for standardized guidelines and best practices to ensure that adverse event costs are fully and accurately represented in oncology drug evaluations.
Reference:
Zhao M et al. Adverse Event Costs and Cost-Effectiveness Analyses of Anticancer Drugs: A Systematic Review. JAMA Netw Open. 2025;8(5):e2512455.
