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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



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.


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.


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

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absolute neutrophil count


Central Eastern Europe


European Organization for Research and Treatment of Cancer


febrile neutropenia


granulocyte colony-stimulating factor


healthcare resource utilization


non-Hodgkin’s lymphoma


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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.


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

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Correspondence to Georgi Mihaylov.

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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


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.

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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).

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