Evaluating the Total Costs of Chemotherapy-Induced Febrile Neutropenia: Results from a Pilot Study with Community Oncology Cancer Patients

Abstract

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the definitions of direct and indirect costs of medical care.2. Describe the feasibility of obtaining information on direct and indirect medical costs associated with febrile neutropenia.3. Identify clinical and nonclinical factors that are associated with larger estimates of direct and indirect medical costs for febrile neutropenia.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTPurpose. While cancer chemotherapy-related febrile neutropenia affects patients' activities and medical expenditures, few studies have reported on the total costs of this condition. Here, we evaluate the feasibility of obtaining detailed and comprehensive cost information on patients who experience febrile neutropenia during cancer chemotherapy treatment. Methods. Community oncology cancer patients who experienced chemotherapy-associated febrile neutropenia recorded information about use of medical care, tests, devices, medications, and lost productivity. Direct cost estimates were derived from Medicare Physician Fee Schedules and cost-to-charge ratios. Indirect cost estimates were based on modified Labor Force, Employment, and Earnings data for employed patients and wages earned by paid caregivers. Multivariate regression models evaluated predictors of higher direct, indirect, and total costs.Results. Outpatients' mean direct and indirect costs were $5,704 and $1,201 (lymphoma), $1,094 and $1,530 (breast cancer), and $1,329 and $1,325 (lung cancer and myeloma), respectively. The mean direct and indirect costs were three-to tenfold and 1.5-to threefold greater for inpatients, respectively. Factors associated with higher direct costs of care included diagnosis of lymphoma and inpatient care; higher indirect costs, male versus female gender; higher total costs, lymphoma diagnosis and inpatient care. Disclosure of potential conflicts of interest is found at the end of this article.

Cost Effectiveness of Integrated Medicine in Patients With Cancer Receiving Anticancer Chemotherapy

“…15 In a pilot study involving patients with cancer from a community oncology center, total direct cost for inpatients being treated for lymphoma averaged €12,325 ($17,869) per patient, compared with a total cost of €7,142 ($10,354) for patients with breast cancer. 16 On the other hand, direct costs for outpatients were remarkably lower (lymphoma, €3,934 [$5,704]; breast cancer, €755 [$1,094]), similar to our findings, which illustrate how direct costs for treatment are lower for outpatients than for inpatients. Interestingly, the overall cost of a TIUH is not related to the patient's origin on a per-patient basis.…”

Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients

“…147 [12] ( 128 [14] (98-158) results from purely theoretical approaches like the recently published papers on the cost-effectiveness of pegfilgrastim versus filgrastim before reaching definite conclusions [31][32][33]. Similarly, asymmetric distribution of cost has been shown for FN [7], CT-induced thrombocytopenia and bleeding [16].…”

“…The existing health economic literature, mainly studies from the United States, focuses on particular toxic effects such as anaemia [11,13], febrile neutropenia (FN) [7,14,15], thrombocytopenia and bleeding [16,17], mucositis [18] and CT-induced nausea and vomiting [2]. However, information on the cumulative cost of toxicity management, e.g.…”

Costs Associated with Capecitabine or 5-Fluorouracil Monotherapy after Surgical Resection in Patients with Colorectal Cancer

“…Several studies, including a recent systematic review, have evaluated the economic burden associated with chemotherapy-related hematologic toxicity in the US [25,26,27]. These studies, taken together, demonstrated that these adverse events had a substantial economic impact on patients, payers, caregivers, and society in general [25].…”