Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;25(9):2787-2795.
doi: 10.1007/s00520-017-3692-x. Epub 2017 Apr 10.

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

Aniket A Kawatkar  1 , Albert J Farias  2   3 , Chun Chao  2 , Wansu Chen  2 , Richard Barron  4 , Florian D Vogl  4 , David B Chandler  4
Affiliations

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

Aniket A Kawatkar et al. Support Care Cancer. 2017 Sep.

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.

Keywords: Febrile neutropenia; Healthcare utilization; Outcomes; Relative dose intensity.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest RB, FV, and DC are employees of and stockholders in Amgen Inc. AK, AF, CC, and WC are employees of KPSC, which received research funding for this study.

References

    1. Caggiano V, Weiss RV, Rickert TS, Linde-Zwirble WT. Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy. Cancer. 2005;103(9):1916–1924. - PubMed
    1. Weycker D, Barron R, Kartashov A, Legg J, Lyman GH. Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings. J Oncol Pharm Pract. 2014;20(3):190–198. - PubMed
    1. Weycker D, Edelsberg J, Kartashov A, Barron R, Lyman G. Risk and healthcare costs of chemotherapy-induced neutropenic complications in women with metastatic breast cancer. Chemotherapy. 2012;58(1):8–18. - PubMed
    1. Hirsch BR, Lyman GH. Pharmacoeconomics of the myeloid growth factors: a critical and systematic review. PharmacoEconomics. 2012;30(6):497–511. - PubMed
    1. Wildiers H, Reiser M. Relative dose intensity of chemotherapy and its impact on outcomes in patients with early breast cancer or aggressive lymphoma. Crit Rev Oncol Hematol. 2011;77(3):221–240. - PubMed