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Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore

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Abstract

Purpose

This prospective cohort study aims to investigate the direct hospitalization costs incurred during febrile neutropenia (FN) in inpatients with underlying hematological conditions and also to elucidate the factors associated with a high cost of managing febrile neutropenia.

Methods

Patients with underlying hematological conditions and documented FN were recruited between October 2008 and February 2011. FN-related costs included all costs incurred from the first day of FN until the last day of antibiotics prescribed. Relevant clinical factors were analyzed using generalized estimating equation models to elucidate the factors that were associated with higher costs of FN.

Results

A total of 175 patients were recruited with 303 documented episodes of FN. In non-transplant patients, 75.6 % of the FN episodes occurred. The median and mean cost incurred for each FN episode was USD9,060 (interquartile range = USD5,047–16,631) and USD15,298 (standard deviation ± USD17,459), respectively, accounting for approximately 38 % of the median total hospitalization cost and 37 % of the mean total hospitalization cost. The ward charges (44.1 %) constituted the largest component of the cost, followed by the laboratory charges (27.3 %) and medications (18.7 %), of which antimicrobials constituted 9.6 % of the cost of FN.

The factors associated with higher costs of FN include cytomegalovirus reactivation (p < 0.001), longer duration of antibiotics (p < 0.001), lower absolute neutrophil count nadir (p < 0.001), allogeneic stem cell transplantation (p < 0.01), and diagnosis of invasive fungal infection (p < 0.05).

Conclusion

The economic cost of management of FN in hematology inpatients is considerable and in addition to the overall risk of mortality for this condition. Strategies to reduce FN or ameliorate its costs are essential for this group of patients.

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Acknowledgments

We would like to thank the hematology team of the National University Hospital for their support for this work.

Conflict of interest

This study was funded internally by the National University Hospital. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no conflict of interest to declare. We have full control of primary data and will permit the journal to review these data if requested.

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Authors and Affiliations

  1. Department of Pharmacy, Singapore General Hospital, Singapore, Singapore

    Yvonne Peijun Zhou

  2. Saw Swee Hock School of Public Health, National University Health System, Singapore, Singapore

    Jing Jin & Li Yang Hsu

  3. Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore, 119228, Singapore

    Ying Ding & Li Yang Hsu

  4. National University Cancer Institute, National University Health System, Singapore, Singapore

    Yen Lin Chee, Liang Piu Koh & Wee Joo Chng

  5. Department of Laboratory Medicine, National University Health System, Singapore, Singapore

    Douglas Su-Gin Chan

Authors
  1. Yvonne Peijun Zhou
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  2. Jing Jin
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  3. Ying Ding
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  4. Yen Lin Chee
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  5. Liang Piu Koh
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  6. Wee Joo Chng
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  7. Douglas Su-Gin Chan
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  8. Li Yang Hsu
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Corresponding author

Correspondence to Li Yang Hsu.

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Zhou, Y.P., Jin, J., Ding, Y. et al. Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore. Support Care Cancer 22, 1447–1451 (2014). https://doi.org/10.1007/s00520-013-2055-5

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  • DOI: https://doi.org/10.1007/s00520-013-2055-5

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