Hospitalizations, outcomes, and management costs of febrile neutropenia in patients from a managed care population

Abstract

Purpose The study objective was to evaluate chemotherapy treatment patterns and incidence, cost, and resource utilization of febrile neutropenia-related hospitalization (FNH) in patients with breast cancer, lung cancer, and non-Hodgkin’s lymphoma (NHL) from Kaiser Permanente Southern California (KPSC), a large integrated delivery system. Methods Adults ≥18 years with any stage breast cancer, lung cancer, or NHL who initiated myelosuppressive chemotherapy from 01/01/2006 to 12/31/2009 were included. Chemotherapy dose delays ≥7 days, relative dose intensity (RDI), regimen switching, FNH and all-cause mortality, granulocyte colony-stimulating factor (G-CSF) and antibiotic use, and healthcare utilization/cost were evaluated by cancer type, regimen, and/or cycle. Results Among 3314 breast cancer patients, 25.3% received an RDI ≤85%, 13.9% experienced FNH with an all-cause mortality rate of 2.0%, and 20.2% received primary prophylaxis with G-CSF. Among those with FNH, mean hospital length of stay (LOS) was 4.1 days, and mean total costs were $20,462. Among 1443 lung cancer patients, 17.9% had an RDI ≤85%, 8.0% experienced FNH with an all-cause mortality rate of 25.2%, and 4.5% received primary prophylaxis with G-CSF. Among those with FNH, mean LOS was 6.8 days, and mean total costs were $32,964. Among 581 NHL patients, 27.9% had an RDI ≤85% and 22.4% experienced FNH with an all-cause mortality rate of 13%. Among those with FNH, mean LOS was 7.9 days, and mean total costs were $37,555. Conclusions Marked variability was observed among different cancer types and chemotherapy regimens. Given the variability, detailed insight into incidence, management, and burden of FN can help inform clinical decision making.

Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement?

“…The aggressive care administered resulted in an average hospital LOS of five days and receipt of broad-spectrum antimicrobial therapy, both of which have a significant impact on healthcare costs and put the patient at risk for adverse events. 4,15,16 Our study findings are consistent with a previous study that reported a 98% non-adherence rate in low-risk patients resulting in a median hospital LOS of four days. 11 Additionally, they found a high adherence rate in those deemed high risk.…”

Supervised, Multimodal Exercise: The Chemotherapy Supportive Therapy That Almost Does It All

“…Exercise can be considered an effective, multifaceted, supportive therapy to achieve these goals. Febrile neutropenia is a common toxicity with myelosuppressive chemotherapy that is associated with substantial morbidity, mortality, and cost . The 13% rate of hospitalization for febrile neutropenia reported in the OptiTrain usual care group was similar to that (13.9%) recently reported in a database analysis of 3,314 patients with breast cancer .…”

“…Febrile neutropenia is a common toxicity with myelosuppressive chemotherapy that is associated with substantial morbidity, mortality, and cost . The 13% rate of hospitalization for febrile neutropenia reported in the OptiTrain usual care group was similar to that (13.9%) recently reported in a database analysis of 3,314 patients with breast cancer . Importantly, the RT‐HIIT OptiTrain intervention significantly reduced hospitalization rates to 3% of patients and also reduced incidence of thrombocytopenia, a less common toxicity that can also increase health care costs.…”

“…Importantly, the RT‐HIIT OptiTrain intervention significantly reduced hospitalization rates to 3% of patients and also reduced incidence of thrombocytopenia, a less common toxicity that can also increase health care costs. The mean total cost of a hospitalization for febrile neutropenia in the database analysis was U.S. $20,462 . Using the OptiTrain incidence data, approximately nine patients would need to be treated with the RT‐HIIT exercise intervention for one additional patient to benefit from reduced hospitalization.…”

Granulocyte Colony Stimulating Factor (G-CSF) Induced Splenic Infarction in Breast Cancer Patient Treated with Dose-Dense Chemotherapy Regimen

“…Febrile neutropenia (FN) is common with chemotherapeutic agents and considered one of the oncologic emergencies [1, 2]. It is associated with a major increase in morbidity and mortality, healthcare resource use, and compromise efficacy of chemotherapy [2–4]. Granulocyte colony-stimulating factor (G-CSF) has been shown to reduce the duration and severity of neutropenia and the risk of febrile neutropenia and enable delivery of full dose-dense chemotherapy when indicated [5–7].…”