Abstract
BackgroundThe primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost. The secondary objective was to describe the out-of-pocket patient payments and the factors that were associated with higher out-of-pocket patient payments.MethodsThis was a single-center observational study conducted at the largest cancer center in Singapore. All of the adult cancer patients hospitalized due to FN from 2009 to 2012 were studied. The primary outcomes were the total hospital cost and the out-of-pocket patient payments (adjusted by government subsidy) per FN episode. Univariate analysis and multiple linear regression were conducted to identify the factors associated with higher FN costs.ResultsThree hundred and sixty seven adult cancer patients were documented with FN-related hospitalizations. The mean total hospital cost was US$4,193 (95% CI: US$3,779-4,607) and the mean out-of-pocket patient payment was US$2,230 (95% CI: US$1,976-2,484), per FN episode. The factors associated with a higher total hospital cost were longer length of stay, severe sepsis, and lymphoma as underlying cancer. The out-of-pocket patient payment was positively associated with longer length of stay, severe sepsis, lymphoma diagnosed as underlying cancer, the therapeutic use of granulocyte colony-stimulating factor (GCSF), the private ward class, and younger patients.ConclusionsThe total hospital cost and out-of-pocket patient payments of FN management in lymphoma cases were substantial compared with other solid tumors. Factors associated with a higher FN management cost may be useful for developing appropriate strategies to reduce the cost of FN for cancer patients.
Highlights
The primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost
The primary objective of this study was to describe the total direct inpatient costs among the solid tumor and lymphoma patients who received inpatient management of chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost
Scheffe’s Test with Bonferroni correction was performed if there was a statistically significant finding through the analysis of variance (ANOVA) test. This step was performed to Patient population Three hundred and sixty seven adult cancer patients were documented with FN-related hospitalizations between 2009 and 2012
Summary
The primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost. A German prospective study [12] analyzed the influence of FN on the use of health resources and costs for patients with both solid cancers and lymphoma and found that the estimated mean direct cost per FN episode requiring hospital care was €3,950. A Spanish study [13] found a mean direct cost per episode attributable to FN of €3,841 in a similar patient population. In a recent study conducted in Ireland [14], the mean cost per FN episode in the inpatient setting was estimated to be €8,915. The cost of FN varies greatly across different countries and health care systems
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