Date: 27 Dec 2012
Costs Associated with Febrile Neutropenia in the US
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Background and Objective: Febrile neutropenia (FN) is a potentially life-threatening condition that may develop in cancer patients treated with myelosuppressive chemotherapy and result in considerable costs. This study was designed to estimate US healthcare utilization and costs in those experiencing FN by location of care, tumour type and mortality.
Methods: Cancer patients who received chemotherapy between 2001 and 2006 were identified from the HealthCore Integrated Research Database®, a longitudinal claims database with enrolment, medical, prescription and mortality information covering 12 health plans and more than 20 million US patients. Patients who experienced FN were prospectively matched using propensity score methods within each tumour type of interest (non-Hodgkin’s lymphoma, breast, lung, colorectal and ovarian cancer) to those not experiencing FN. Health resource utilization was compared per patient per month for unique prescriptions and visits (inpatient and outpatient) over the length of follow-up. Healthcare total paid costs adjusted to 2009 US dollars per patient per month were examined by FN group (FN vs non-FN, FN died vs FN survived), by source of care (physician office visit, outpatient services, hospitalization and prescriptions) and by tumour type. The number of unique FN-related encounters (inpatient and outpatient) and the number of patients experiencing at least one FN-related encounter were examined. The costs per encounter were tabulated. FN encounters differ from FN episodes in that a single FN episode may include multiple FN encounters (i.e. a patient is seen multiple times [encounters] for treatment of a single FN event [episode]).
Results: A total of 5990 patients each were successfully matched between the FN and non-FN (control) groups. Health resource utilization was generally higher in those with FN than in controls. FN patients incurred greater costs (mean ± SD: $US9628±12517 per patient-month) than non-FN patients ($US8478±12978). Chemotherapy comprised the majority of costs for both FN (33.5%) and non-FN (40.6%) patients. The largest cost difference by categorical source of care was for hospitalization (p<0.001). FN patients who died had the highest mean total costs compared with FN surviving patients ($US21 214 ± 25 596 per patient-month vs $US8227 ± 8850, respectively). Follow-up time for those surviving was, on average, 6.6 months longer. Hospitalization accounted for 53.1% of costs in those experiencing mortality with FN, while chemotherapy accounted for the majority of costs (37.1%) in surviving FN patients. A total of 6574 patients with at least one FN encounter experienced a total of 55 726 unique FN-related encounters, 90% of which were outpatient in nature. The majority of FN-related encounters (79%) occurred during the first chemotherapy course. The average costs for FN encounters were highest for inpatient encounters, $US22 086 ± 43 407, compared with $US985±1677 for outpatient encounters.
Conclusions: The occurrence of FN in cancer patients receiving chemotherapy results in greater healthcare resource utilization and costs, with FN patients who die accounting for the greatest healthcare costs. Most FN patients experience at least one outpatient FN encounter, and the total cost of treatment for FN continues to be high.
Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993 May 6, 1993; 328(18): 1323–32
Crawford J, Dale DC, Kuderer NM, et al. Risk and timing of neutropenic events in adult cancer patients receiving chemotherapy: the results of a prospective nationwide study of oncology practice. J Natl Compr Canc Netw 2008 Feb;6(2): 109–18PubMed
Stokes ME, Muehlenbein CE, Marciniak MD, et al. Neutropenia-related costs in patients treated with first-line chemotherapy for advanced non-small cell lung cancer. J Manag Care Pharm 2009 Oct; 15(8): 669–82PubMed
Chang J. Chemotherapy dose reduction and delay in clinical practice. evaluating the risk to patient outcome in adjuvant chemotherapy for breast cancer. Eur J Cancer 2000 Apr; 36 Suppl. 1: S1 1–4
Clark OA, Lyman G, Castro AA, et al. Colony stimulating factors for chemotherapy induced febrile neutropenia. Cochrane Database Syst Rev 2003; (3): CD003039PubMed
von Minckwitz G, Schwenkglenks M, Skacel T, et al. Febrile neutropenia and related complications in breast cancer patients receiving pegfilgrastim primary prophylaxis versus current practice neutropaenia management: results from an integrated analysis. Eur J Cancer 2009 Mar; 45(4): 608–17CrossRef
Heckman J, Ichimura H, Todd P. Matching as an econometric evaluation estimator: evidence from evaluating a job training programme. Rev Econ Stud 1997; 64: 605–54CrossRef
Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983 Apr 1; 70(1): 41–55CrossRef
Rosenbaum P, Rubin D. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985 Feb; 39(1): 33–8
Gold MR. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
Efron B, Tibshirani R. An introduction to the bootstrap. New York: Chapman & Hall, 1993
Segal BH, Freifeld AG, Baden LR, et al. Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw 2008 Feb; 6(2): 122–74PubMed
- Costs Associated with Febrile Neutropenia in the US
Volume 30, Issue 9 , pp 809-823
- Cover Date
- Print ISSN
- Online ISSN
- Springer International Publishing
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. United BioSource Corporation, Lexington, Massachusetts, USA
- 2. Amgen Inc., Thousand Oaks, California, USA
- 3. HealthCore, Wilmington, Delaware, USA
- 4. Duke University and the Duke Comprehensive Cancer Center, Durham, North Carolina, USA