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memo - Magazine of European Medical Oncology

, Volume 9, Issue 3, pp 144–152 | Cite as

Healthcare resource utilization and G‑CSF use in patients with solid tumors or hematological malignancies hospitalized for febrile neutropenia in Bulgaria, Czech Republic and Slovakia

  • Georgi MihaylovEmail author
  • Zhasmina Mihaylova
  • Lubos Drgona
  • Andrea Cipkova
  • Jan Novak
  • Roumyana Petrova
original report
  • 68 Downloads

Summary

Background

Febrile neutropenia (FN) is a common side effect of chemotherapy that frequently necessitates hospitalization and healthcare resource utilization (HCRU), but is poorly studied in Eastern European countries. We investigated HCRU and granulocyte colony-stimulating factor (G-CSF) use in patients hospitalized for FN in Bulgaria, Czech Republic, and Slovakia.

Patients and methods

This was a multicenter retrospective cohort study. Eligible patients were ≥18 years old, had received chemotherapy for solid tumors or hematological malignancies of any stage, and had been hospitalized for FN. The primary objective was to evaluate FN-related HCRU; secondary objectives included the description of chemotherapy treatment patterns and G‑CSF use. Data were analyzed by participating country.

Results

Data of 156 patients from Bulgaria and 79 patients each from the Czech Republic and Slovakia were analyzed. The most frequent solid tumors were breast (n = 28) and testicular cancer (n = 13), and the most common hematological malignancies were non-Hodgkin B‑cell lymphoma (n = 51) and acute myeloid leukemia (n = 35). In general, G‑CSF was used to treat FN rather than as prophylaxis. Most patients had a single FN episode, predominantly in cycle 1. The mean duration of FN-related hospitalization was 7–9 days, with longer stays in patients with hematological malignancies.

Conclusions

Results indicate considerable FN-related HCRU in all countries. Frequent lack of G‑CSF primary prophylaxis was observed, particularly in Slovakia.

Keywords

Febrile neutropenia Granulocyte colony-stimulating factor Health care resource utilization Chemotherapy Central Eastern Europe 

Abbreviation

ANC

absolute neutrophil count

CEE

Central Eastern Europe

EORTC

European Organization for Research and Treatment of Cancer

FN

febrile neutropenia

G-CSF

granulocyte colony-stimulating factor

HCRU

healthcare resource utilization

NHL

non-Hodgkin’s lymphoma

Notes

Acknowledgements

The authors would like to thank the study investigators for participating and enrolling patients into the study. Medical writing assistance was provided by Margit Hemetsberger, hemetsberger medical services, Vienna, Austria, and Olga Garbuzenko, Quartesian, Princeton, NJ, USA.

Funding

This study was funded by Amgen Central Eastern Europe Headoffice, Vienna, Austria.

Conflict of interest

G. Mihaylov, Z. Mihaylova, A. Cipkova, and J. Novak declare that they have no competing interests. R. Petrova is an employee of Amgen s.r.o., Sofia, Bulgaria. L. Drgona declares to have received payments from Amgen for patient recruitment and for consultation during study preparation, honoraria for presentations from Sandoz, and consultation fees and honoraria for presentations from Teva.

Supplementary material

12254_2016_279_MOESM1_ESM.docx (71 kb)
The Electronic Supplementary Material is intended to support payors, decision makers, and health economics experts to make their own cost calculations. It contains details on the specific healthcare resource use variables on which data was collected. It also contains detailed tables of the findings and sensitivity analyses.

References

  1. 1.
    Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228–37.CrossRefPubMedGoogle Scholar
  2. 2.
    Green MD, Koelbl H, Baselga J, et al. A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol. 2003;14(1):29–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Holmes FA, Jones SE, O’Shaughnessy J, et al. Comparable efficacy and safety profiles of once-per-cycle pegfilgrastim and daily injection filgrastim in chemotherapy-induced neutropenia: a multicenter dose-finding study in women with breast cancer. Ann Oncol. 2002;13(6):903–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Holmes FA, O’Shaughnessy JA, Vukelja S, et al. Blinded, randomized, multicenter study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high-risk stage II or stage III/IV breast cancer. J Clin Oncol. 2002;20(3):727–31.CrossRefPubMedGoogle Scholar
  5. 5.
    Aapro MS, Bohlius J, Cameron DA, et al. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer. 2011;47(1):8–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Kuderer NM, Dale DC, Crawford J, et al. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006;106(10):2258–66.CrossRefPubMedGoogle Scholar
  7. 7.
    Hirsch BR, Lyman GH. Pharmacoeconomics of the myeloid growth factors: a critical and systematic review. Pharmacoeconomics. 2012;30(6):497–511.CrossRefPubMedGoogle Scholar
  8. 8.
    Schilling MB, Parks C, Deeter RG. Costs and outcomes associated with hospitalized cancer patients with neutropenic complications: A retrospective study. Exp Ther Med. 2011;2(5):859–66.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Lyman GH, Dale DC, Crawford J. Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol. 2003;21(24):4524–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Weycker D, Danel A, Bendall K, et al. Cost of chemotherapy-induced febrile neutropenia treated in inpatient, outpatient, and home care settings among adults with non-Hodgkin’s lymphoma in European clinical practice. Blood. 2011;118:4200, ASH Annual Meeting Abstracts.Google Scholar
  11. 11.
    Weycker D, Barron R, Kartashov A, et al. Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings. J Oncol Pharm Pract. 2014;20(3):190–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Saramago P, Andreozzi V, Ferreira JM, et al. Modelling the direct costs of chemotherapy-induced neutropenia treatment in Portuguese hospitals clinical practice. J Clin Oncol. 2007;25(18S):17081, ASCO Annual Meeting Proceedings (Post-Meeting Edition), June 20 Supplement.Google Scholar
  13. 13.
    Mayordomo JI, Lopez A, Vinolas N, et al. Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain. Curr Med Res Opin. 2009;25(10):2533–42.CrossRefPubMedGoogle Scholar
  14. 14.
    Ihbe-Heffinger A, Paessens BJ, von Schilling C, et al. Management of febrile neutropenia – a German prospective hospital cost analysis in lymphoproliferative disorders, non-small cell lung cancer, and primary breast cancer. Onkologie. 2011;34(5):241–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Moeremans K, Caekelbergh K, Spaepen E. et al. Economic aspects and drivers of febrile neutropenia in cancer – a multicentre retrospective analysis in Belgium. ISPOR 8th Annual European Congress, Florence. 2005.Google Scholar
  16. 16.
    Liu Z, Doan QV, Malin J, et al. The economic value of primary prophylaxis using pegfilgrastim compared with filgrastim in patients with breast cancer in the UK. Appl Health Econ Health Policy. 2009;7(3):193–205.CrossRefPubMedGoogle Scholar
  17. 17.
    Vainchtock A, Cohen-Nizard S, Durand-Zaleski I. Analysis of public and private hospital databases (PMSI) 2010/2011 to estimate the frequency and associated costs for febrile neutropenia in france. ISPOR 16th Annual European Congress, Dublin. 2013.Google Scholar
  18. 18.
    Mattli R, Pletscher M, Eichler K. et al. Inpatient hospital costs of febrile neutropenia as a consequence of chemotherapy for breast cancer and Non-Hodgkin Lymphoma in Switzerland. ISPOR 16th Annual European Congress, Dublin. 2013.Google Scholar
  19. 19.
    Liou SY, Stephens JM, Carpiuc KT, et al. Economic burden of haematological adverse effects in cancer patients: a systematic review. Clin Drug Investig. 2007;27(6):381–96.CrossRefPubMedGoogle Scholar
  20. 20.
    Kuderer NM, Dale DC, Crawford J, et al. Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review. J Clin Oncol. 2007;25(21):3158–67.CrossRefPubMedGoogle Scholar
  21. 21.
    Caggiano V, Weiss RV, Rickert TS, et al. Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer. 2005;103(9):1916–24.CrossRefPubMedGoogle Scholar
  22. 22.
    Kuderer NM. Meta-analysis of randomized controlled trials of granulocyte colony-stimulating factor prophylaxis in adult cancer patients receiving chemotherapy. Cancer Treat Res. 2011;157:127–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Crawford J, Glaspy JA, Stoller RG, et al. Final results of a placebo-controlled study of filgrastim in small-cell lung cancer: exploration of risk factors for febrile neutropenia. Support Cancer Ther. 2005;3(1):36–46.CrossRefPubMedGoogle Scholar
  24. 24.
    Fiegl M, Steger GG, Studnicka M, et al. Pegfilgrastim prophylaxis in patients at different levels of risk for chemotherapy-associated febrile neutropenia: an observational study. Curr Med Res Opin. 2013;29(5):505–15.CrossRefPubMedGoogle Scholar
  25. 25.
    Maenpaa J, Varthalitis I, Erdkamp F, et al. The use of granulocyte colony stimulating factor (G-CSF) and management of chemotherapy delivery during adjuvant treatment for early-stage breast cancer – further observations from the IMPACT solid study. Breast. 2016;25:27–33.CrossRefPubMedGoogle Scholar
  26. 26.
    World Health Organization. Access to new medicines in Europe: technical review of policy initiatives and opportunities for collaboration and research 2015. http://www.euro.who.int/__data/assets/pdf_file/0008/306179/Access-new-medicines-TR-PIO-collaboration-research.pdf?ua=1. Accessed 20 July 2015.Google Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Georgi Mihaylov
    • 1
    Email author
  • Zhasmina Mihaylova
    • 2
  • Lubos Drgona
    • 3
  • Andrea Cipkova
    • 4
  • Jan Novak
    • 5
  • Roumyana Petrova
    • 6
  1. 1.Specialized Hospital for Active Treatment of Hematology Diseases EADClinic of Clinical HematologySofiaBulgaria
  2. 2.Department of Medical OncologyMilitary Medical Academy Multiprofile Hospital for Active Treatment SofiaSofiaBulgaria
  3. 3.Department of OncohematologyComenius University and National Cancer InstituteBratislavaSlovakia
  4. 4.Eastern-Slovakian Cancer InstituteKosiceSlovakia
  5. 5.Hematology DepartmentFaculty Hospital Kralovske VinohradyPragueCzech Republic
  6. 6.Amgen Bulgaria EOODSofiaBulgaria

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