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.

Keywords: :

• Drug therapy
• Fever
• Healthcare costs
• Neutropenia

Transparency

Declaration of funding

This study was supported by Amgen SA, Barcelona. The statistical analysis and the medical writing support were also funded by Amgen SA (Barcelona).

Declaration of financial/other relationships

J.A.G. and J.S. are employees of Amgen SA (Barcelona, Spain). M.L. is an employee of Health Economics and Outcomes Research, IMS Health, Barcelona. J.I.M., A.L., N.V., J.C., S.P., J.D.A. and A.F. have disclosed that they have no relevant financial relationships.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewers 1, 2 and 3 have disclosed that they have no relevant financial relationships.

Acknowledgment

The authors acknowledge and thank the following staff from Health Economics and Outcomes Research. IMS Health (Barcelona, Spain): Núria Lara and Evelyn Cadenas for managing the study and Àgata Carreño for the statistical analysis. The authors also thank the study coordinators and patients at each of the participating centers.

The ENIA Study Group: J. Castellanos, Hospital Xeral-Cíes, Vigo; A. Gúrpide, Clinica Universitaria de Navarra, Pamplona; N. Viñolas, Hospital Clínic i Provincial, Barcelona; A. López, Hospital Vall d’Hebron, Barcelona; S. Pernas, Institut Català d’Oncologia, L’Hospitalet; J.I. Mayordomo, Hospital Clínico Lozano Blesa, Zaragoza; A. Frau, Hospital Provincial, Castellón; J.D. Alonso, Hospital Virgen de la Arrixaca, Murcia; A. Novo, Hospital Son Dureta, Palma de Mallorca; J. Gómez, Hospital Universitario La Fe, Valencia; J. L. González, Hospital Clínico San Carlos, Madrid; A. Velasco, Hospital de la Princesa, Madrid; C. Herrera, Hospital Reina Sofía, Córdoba; M. Ruiz, Hospital Virgen del Rocío, Sevilla; F. Álvarez, Hospital Infanta Cristina, Badajoz; M̂. J. Lamas, Hospital Clínico Universitario, Santiago de Compostela.