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

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.

This is a preview of subscription content, log in to check access.

Abbreviations

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

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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  7. 7.

    Hirsch BR, Lyman GH. Pharmacoeconomics of the myeloid growth factors: a critical and systematic review. Pharmacoeconomics. 2012;30(6):497–511.

    Article  PubMed  Google 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.

    PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

  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.

    Article  PubMed  Google 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.

  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.

  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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  Google 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 

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Georgi Mihaylov.

Ethics declarations

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.

Additional information

Prior conference presentations: Mihaylov G, Mihaylova Z, Drgona L, Cipkova A, Novak J, Petrova R. Healthcare resource utilization (HCRU) in hospitalized febrile neutropenia (FN) patients treated with chemotherapy for solid tumors (ST) and hematological malignancies (HM) in Bulgaria (BG), Czech Republic (CZ) and Slovakia (SK) as observed in clinical practice. ISPOR 17th Annual European Congress, Amsterdam, The Netherlands, 8–12 November 2014; abstract and poster code PCN245. Gercheva L, Goranov S, Raynov J, Mihaylova Z, Mihaylov G, Karanikolov S, Petrova R. Healthcare resource utilization (HCRU) in hospitalized febrile neutropenia (FN) patients treated with chemotherapy for solid tumors (ST) and hematological malignancies (HM) in Bulgaria. ISPOR 17th Annual European Congress, Amsterdam, The Netherlands, 8–12 November 2014; abstract and poster code PCN238

Caption Electronic Supplementary Material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mihaylov, G., Mihaylova, Z., Drgona, L. et al. 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. memo 9, 144–152 (2016). https://doi.org/10.1007/s12254-016-0279-z

Download citation

Keywords

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