A retrospective study of the clinical and economic burden during hospitalizations among cancer patients with febrile neutropenia

Abstract

Objective:

The objective of this study was to provide up-to-date estimates of the clinical and economic burden that occurs during inpatient treatment of cancer patients with febrile neutropenia (FN).

Methods:

A retrospective cohort study was conducted using 2007–2010 hospital discharge data from the Premier database. The study population included adult patients with discharge diagnoses of neutropenia (ICD-9 code 288.0x) with fever or infection and receipt of intravenous antibiotics and female breast cancer, lung cancer, colorectal cancer, ovarian cancer, non-Hodgkin lymphoma (NHL), or Hodgkin lymphoma. Primary study outcomes were inpatient mortality, hospital length of stay (LOS), and total hospitalization cost for each patient’s first FN-related hospitalization. Logistic regressions (for mortality) and multivariate linear regressions (for LOS and cost) were conducted to assess the effect of comorbidities and infection types on study outcomes, adjusting for other patient and hospital characteristics.

Results:

Among 16,273 cancer patients hospitalized with FN, the inpatient case fatality rate was 10.6%, mean LOS was 8.6 days, and mean total hospitalization cost was $18,880. Lung cancer patients had the highest inpatient case fatality rate (15.7%), and NHL patients had the longest LOS (10.1 days) and the highest cost ($24,218). Multivariate analyses showed that most comorbidities were associated with a greater risk of mortality, longer LOS, and higher cost. Septicemia/bacteremia and pneumonia were associated with a greater risk of mortality, and most types of infection were associated with a longer LOS and higher cost.

Limitations:

The total burden of FN may be under-estimated in this study because outpatient treatment and any patient deaths or costs that occurred outside of Premier hospitals could not be captured.

Conclusions:

FN-related hospitalizations among cancer patients are costly and accompanied by considerable mortality risk. Substantial differences in the clinical and economic burden of FN exist depending on cancer types, comorbidities, and infection types.

Keywords::

• Mortality
• Length of stay
• Cost
• Inpatient
• Cancer
• Hospitalization
• Febrile neutropenia

Transparency

Declaration of funding

This study was sponsored by Amgen Inc.

Declaration of financial/other relationships

X. Li, R. L. Barron, and J. C. Legg are employees of and stockholders in Amgen Inc. J. A. Gayle and F. R. Ernst are employees of Premier healthcare alliance, which received funding from Amgen Inc. B. Dulisse was an employee of Premier healthcare alliance at the time this study was conducted. K. J. Rothman and J. A. Kaye are employees of RTI Health Solutions, an independent, non-profit research organization which was engaged by Amgen Inc. to consult on the design of the study and interpretation of the results. JME Peer Reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

The authors thank Dr. Gary H. Lyman for kindly providing the ICD-9 codes for comorbidities and infection types used by Kuderer et al3. Kerri Hebard-Massey (Amgen Inc.) provided medical writing support.