Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain

Abstract

Background:Febrile neutropenia (FN) is associated with disruption of planned chemotherapy and increased management costs. However, the economic impact of FN in Spanish clinical practice has not been documented hitherto.Research design and methods:A multicenter, retrospective chart review of adults with breast or lung cancer or non-Hodgkin's lymphoma (NHL) who had ≥1 FN episode during chemotherapy. Resource use, direct costs, and FN effect on planned chemotherapy were assessed.Main outcome measures:238 episodes of FN were analyzed in 194 patients. The mean ± SD length of FN-related hospitalization was 8.7 ± 6.9 days (median [p25–p75] = 7 [5–11] days). At least one transfusion was needed in 77 (32.3%) FN episodes, blood tests were done in 233 (97.9%) and blood cultures in 207 (87.0%). Antibiotics were used in all episodes (100%), other drugs in 186 (78.2%) episodes and the granulocyte colony-stimulating factor (G-CSF) in 161 (67.7%) episodes. The distribution of costs per episode of FN were: hospitalization 79%, antibiotics 10%, G-CSF 5%, complementary tests 4%; other drugs 1%, blood transfusions 1%. The estimated mean (95% CI) cost per FN episode was €3841 (95% CI: €3476–4206). FN management was costlier in NHL patients €4514 (95% CI: €3805–5223) than in breast or lung cancer patients (€3519 [95% CI: €2976–4061] and €3311 [95% CI: €2817–3805] respectively) (P < 0.05 both comparisons). Planned chemotherapy was disrupted in 139 (58.4%) episodes (dose reductions in 75 [34.9%], dose delays in 60 [28.0%] and withdrawal in 33 [14.7%]).Conclusions:FN substantially affects healthcare resource use and costs in breast cancer, lung cancer and, NHL. In this study, hospitalization and antibiotics were the main drivers of cost. A limitation of the analysis was that it did not include the indirect costs associated with FN episodes.