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

• Published in: Supportive care in cancer Vol. 22; no. 6; pp. 1447 - 1451
• Main Authors: Zhou, Yvonne Peijun, Jin, Jing, Ding, Ying, Chee, Yen Lin, Koh, Liang Piu, Chng, Wee Joo, Chan, Douglas Su-Gin, Hsu, Li Yang
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2014; Springer; Springer Nature B.V
• Subjects: Adult; Analysis; Anti-infective agents; Blood diseases; Cancer; Chemotherapy; Cohort Studies; Cytomegalovirus infections; Economic aspects; Febrile Neutropenia - economics; Febrile Neutropenia - etiology; Febrile Neutropenia - therapy; Female; Fever; Health aspects; Health Care Costs; Health care expenditures; Hematologic Diseases - complications; Hematologic Diseases - economics; Hematologic Diseases - therapy; Hematologic Neoplasms - complications; Hematologic Neoplasms - economics; Hematologic Neoplasms - therapy; Hematology; Hospital patients; Hospitalization; Hospitalization - economics; Humans; Inpatients; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Mycoses; Neutropenia; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Prospective Studies; Rehabilitation Medicine; Singapore; Stem cells; Singapore; Hospitalization costs; Stem cell transplantation; Chemotherapy; Hematology; Febrile neutropenia
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-013-2055-5

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.