Costs associated with febrile neutropenia in solid tumor and lymphoma patients – an observational study in Singapore

BMC Health Services Research

Alexandre Chan¹  Li Yang Hsu³  Mabel Wong²  Xiao Jun Wang¹ 

[1] Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore;Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore;Department of Medicine, National University Health System Singapore, Singapore, Singapore

关键词: Factors;    Cost analysis;    Fever;    Neutropenia;    Febrile neutropenia;   

Others  :  1126162
DOI  :  10.1186/1472-6963-14-434

 received in 2014-06-16, accepted in 2014-09-23,  发布年份 2014

【 摘 要 】

Background

The primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost. The secondary objective was to describe the out-of-pocket patient payments and the factors that were associated with higher out-of-pocket patient payments.

Methods

This was a single-center observational study conducted at the largest cancer center in Singapore. All of the adult cancer patients hospitalized due to FN from 2009 to 2012 were studied. The primary outcomes were the total hospital cost and the out-of-pocket patient payments (adjusted by government subsidy) per FN episode. Univariate analysis and multiple linear regression were conducted to identify the factors associated with higher FN costs.

Results

Three hundred and sixty seven adult cancer patients were documented with FN-related hospitalizations. The mean total hospital cost was US$4,193 (95% CI: US$3,779-4,607) and the mean out-of-pocket patient payment was US$2,230 (95% CI: US$1,976-2,484), per FN episode. The factors associated with a higher total hospital cost were longer length of stay, severe sepsis, and lymphoma as underlying cancer. The out-of-pocket patient payment was positively associated with longer length of stay, severe sepsis, lymphoma diagnosed as underlying cancer, the therapeutic use of granulocyte colony-stimulating factor (GCSF), the private ward class, and younger patients.

Conclusions

The total hospital cost and out-of-pocket patient payments of FN management in lymphoma cases were substantial compared with other solid tumors. Factors associated with a higher FN management cost may be useful for developing appropriate strategies to reduce the cost of FN for cancer patients.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Zhou YP, Jin J, Ding Y, Chee YL, Koh LP, Chng WJ, Chan DS, Hsu LY: Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore. Supportive Care in Cancer 2014, 22:1447-1451.
• [2]Caggiano V, Weiss RV, Rickert TS, Linde-Zwirble WT: Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer 2005, 103:1916-1924.
• [3]Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH: Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006, 106:2258-2266.
• [4]Poon LM, Jin J, Chee YL, Ding Y, Lee YM, Chng WJ, Chai LY, Tan LK, Hsu LY: Risk factors for adverse outcomes and multidrug-resistant Gram-negative bacteraemia in haematology patients with febrile neutropenia in a Singaporean university hospital. Singapore Med J 2012, 53:720-725.
• [5]Lyman GH: Guidelines of the National Comprehensive Cancer Network on the use of myeloid growth factors with cancer chemotherapy: a review of the evidence. Journal of the National Comprehensive Cancer Network: JNCCN 2005, 3:557-571.
• [6]Lyman GH, Dale DC, Friedberg J, Crawford J, Fisher RI: Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide study. J Clin Oncol Off J Am Soc Clin Oncol 2004, 22:4302-4311.
• [7]Lyman GH, Morrison VA, Dale DC, Crawford J, Delgado DJ, Fridman M: Risk of febrile neutropenia among patients with intermediate-grade non-Hodgkin’s lymphoma receiving CHOP chemotherapy. Leukemia & lymphoma 2003, 44:2069-2076.
• [8]Bosly A, Bron D, Van Hoof A, De Bock R, Berneman Z, Ferrant A, Kaufman L, Dauwe M, Verhoef G: Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP. Ann Hematol 2008, 87:277-283.
• [9]Liou SY, Stephens JM, Carpiuc KT, Feng W, Botteman MF, Hay JW: Economic burden of haematological adverse effects in cancer patients: a systematic review. Clinical drug investigation 2007, 27:381-396.
• [10]Dulisse B, Li X, Gayle JA, Barron RL, Ernst FR, Rothman KJ, Legg JC, Kaye JA: A retrospective study of the clinical and economic burden during hospitalizations among cancer patients with febrile neutropenia. J Med Econ 2013, 16:720-735.
• [11]Michels SL, Barron RL, Reynolds MW, Smoyer Tomic K, Yu J, Lyman GH: Costs associated with febrile neutropenia in the US. PharmacoEconomics 2012, 30:809-823.
• [12]Ihbe-Heffinger A, Paessens BJ, von Schilling C, Shlaen M, Gottschalk N, Berger K, Bernard R, Kiechle M, Peschel C, Jacobs VR: Management of febrile neutropenia–a German prospective hospital cost analysis in lymphoproliferative disorders, non-small cell lung cancer, and primary breast cancer. Onkologie 2011, 34:241-246.
• [13]Mayordomo JI, Lopez A, Vinolas N, Castellanos J, Pernas S, Domingo Alonso J, Frau A, Layola M, Antonio Gasquet J, Sanchez J, Group ES: Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain. Curr Med Res Opin 2009, 25:2533-2542.
• [14]O’Brien C, Fogarty E, Walsh C, Dempsey O, Barry M, Kennedy MJ, McCullagh L: The cost of the inpatient management of febrile neutropenia in cancer patients - a micro-costing study in the Irish healthcare setting. European Journal Cancer Care 2014. doi:10.1111/ecc.12182 [Epub]
• [15]Chan A, Wong QX, Ali MK, Wong M, Hsu LY: Clinical efficacy of adjunctive G-CSF on solid tumor and lymphoma patients with established febrile neutropenia. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer 2014, 22:1105-1112.
• [16]National Cancer Centre Singapore. Director’s Message. Available from http://www.nccs.com.sg/AboutUs/DirectorMessage/Pages/Home.aspx webcite [Assessed March 04, 2014]
• [17]Wong M, Jin J, Tan MH, Lee YM, Lee TE, Ding Y, Yong HC, Lim SE, Chai LY, Chau NM, Hsu LY: Prospective audit of post-chemotherapy febrile neutropenia in patients with solid cancer and lymphoma in two Singaporean cancer centres. Ann Acad Med Singap 2012, 41:287-293.
• [18]Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of A: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2011, 52:e56-e93.
• [19]Singapore General Hospital. Patient Services: Types of Wards. Available from: http://www.sgh.com.sg/patient-services/charges-payment/pages/types-wards.aspx webcite [Assessed March 04, 2014]
• [20]Ministry of Health Singapore. Healthcare Services and Facilities: Hospital Services. Available from: http://www.moh.gov.sg/content/moh_web/home/our_healthcare_system/Healthcare_Services/Hospitals.html webcite [Assessed March 04, 2014]
• [21]Department of Statistics Singapore. Singapore Consumer Price Index. Avaliable from: http://www.singstat.gov.sg/publications/publications_and_papers/prices/consumer_price_index.html webcite [Accessed March 10, 2014]
• [22]Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J: The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol Off J Am Soc Clin Oncol 2000, 18:3038-3051.
• [23]Bennett CL, Calhoun EA: Evaluating the total costs of chemotherapy-induced febrile neutropenia: results from a pilot study with community oncology cancer patients. Oncologist 2007, 12:478-483.
• [24]Ministry of Health Singapore. Schemes & Subsidies: How MediShield Works. Available from: http://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/Medishield/How_MediShield_Works.html webcite [Assessed August 21, 2014]
• [25]Khalili H, Karimzadeh I, Mirzabeigi P, Dashti-Khavidaki S: Evaluation of clinical pharmacist’s interventions in an infectious diseases ward and impact on patient’s direct medication cost. European journal of internal medicine 2013, 24:227-233.
• [26]Schilling MB, Parks C, Deeter RG: Costs and outcomes associated with hospitalized cancer patients with neutropenic complications: a retrospective study. Experimental and therapeutic medicine 2011, 2:859-866.