Cost of febrile neutropenia management in cancer patients in Spain

Abstract

6089 Background: Febrile neutropenia (FN), a dose-limiting event for many myelosuppressive chemotherapy (CT) regimens, often causes subsequent CT dose delays (DD) and reductions (DR), lengthens hospital stay and increases monitoring, diagnostic and treatment costs. No studies are known to date on economic costs of FN in common clinical practice in Spain. Methods: This is a multicentre, retrospective, observational chart review of adult patients with breast cancer, lung cancer or non-Hodgkin’s lymphoma (NHL) who suffered from at least one FN episode related to cytotoxic CT from 16 Spanish hospitals. Resource use and subsequent costs including days of hospitalization, number of RBC transfusions, number and type of complementary tests, use of colony-stimulating factors (CSF), antibiotics and other drugs to manage FN were assessed. Potential impact of FN on planned CT dose and/or schedule was also analysed. P-value was obtained by one-way ANOVA using the Bonferroni correction. Results: A total of 194 medical charts including 238 documented FN episodes were reviewed. Women, 59.8%; age > 60 yrs, 49.5%; breast cancer, 43% (83% treated with taxane or anthracycline-based CT); lung cancer, 22% (95.5% treated with platinum-based CT); NHL, 35% (58.2% treated with CHOP-like CT). Hospitalization due to FN lasted a median of 7 days. During the episode, 32.3% of pts needed 1 or more RBC transfusions, 97.9% required a blood test and 87% a blood culture. CSFs were used in 67.6% of pts. All pts were treated with antibiotics and 78.2% with other drugs. 58.4% of FN episodes had an impact on planned CT dose and/or schedule: DR was observed in 34.9% of cases, DD in 28% and CT withdrawal in 14.7%. Conclusions: Main drivers of cost of FN are hospitalization and antibiotic treatment. FN is more costly in NHL pts than breast or lung pts (statistically significant in lung pts). FN episodes have a relevant impact on planned CT dose and/or schedule. In each row statistically significant differences ( p<0.05) were obtained between values with the same letter. [Table: see text] [Table: see text]

Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now?

“…An analysis in >40,000 US patients found that, on average, an FN episode resulted in a median hospital stay of 6 days and a median cost of $8,376, with 35% of patients being hospitalised for at least 10 days [ 3 ]. Smaller studies from various western European countries have provided estimates of the average charge for FN-related hospitalisation ranging from €2,619 in Spain to €4,931 in France [ 4 , 104 , 105 ]. These findings highlight the need to implement official guidelines for preventing FN.…”

Clinical practice guidelines for the use of colony-stimulating factors in cancer treatment: Implications for oncology nurses

“…In the European study by Pettengell et al (2006), about 30% of patients with lymphoma received an RDI p85% of what was planned, and multivariate regression analysis showed that the occurrence of FN in the first cycle was a predictor of low RDI. A retrospective chart review carried out in 16 Spanish hospitals in 2005 found that of 83 patients with breast cancer who developed FN, 42% required one or more chemotherapy dose reductions, 31% required one or more chemotherapy dose delays, and 17% discontinued chemotherapy altogether (Mayordomo et al, 2006). Another subgroup analysis of this study was in 67 patients with lymphoma who developed FN.…”

“…determined that the average total cost per episode was 4514 for patients with lymphoma (López et al, 2006) and 3519 for patients with breast cancer (Mayordomo et al, 2006). The median length of hospital stay was 8 days for patients with lymphoma and 6 days for patients with breast cancer, and, as in the early UK study, the main drivers of the cost of managing FN were hospitalisation and antibiotic treatment (López et al, 2006;Mayordomo et al, 2006).…”

“…The rates of FN were 15% (95% CI, 8-27%) and 22% (95% CI, 17-28%) in the two groups, respectively. A retrospective chart review of patients with breast cancer treated at 16 Spanish hospitals between April and June of 2005 showed that 18% of 83 patients suffered from more than one FN episode (Mayordomo et al, 2006). In the United States, a prospective registry study of more than 4000 patients treated with systemic chemotherapy for one of six major cancer types documented that 24% of patients had CIN and 14% had FN (Crawford et al, 2004b).…”

Prophylactic G-CSF in patients with early-stage breast cancer: a health economic review

“…In a retrospective study from Spain, the estimated cost of FN was €3519 (∼£2360) per episode ( Mayordomo et al , 2006 ). This is broadly in line with estimates from the United Kingdom, where the reference cost (essentially the charge to the payer) for an admission with FN is approximately £3300–£4300 and a recent review conducted by the National Institute for Health and Clinical Excellence (NICE) estimated a cost of about £3330 per FN episode ( NICE, 2008 ).…”