Economic Burden of Febrile Neutropenia in NHL Exceeds $11,000 per Episode

Caroline Helwick

March 2012, Vol 3, No 2 - ASH Annual Meeting

San Diego, CA—Among patients with non-Hodgkin lymphoma (NHL), costs related to febrile neutropenia (FN) treated with hospitalization exceed $11,000 per episode, researchers reported at ASH 2011. Although the research was conducted on patients in the United Kingdom, the investigators converted costs to US dollars and noted that their findings were in keeping with previous published US studies. "Our key point is that a high level of resource utilization is required in managing FN when it occurs in NHL patients," Derek Weycker, PhD, Policy Analysis, Brookline, MA, told Value- Based Cancer Care. "There are significant costs associated with the development of FN; therefore, it's a good idea to prevent it."

Data were obtained from an observational study of supportive care in patients with NHL receiving standard chemotherapy (with or without rituximab) for NHL. Patients developing FN in a given cycle were matched to control patients not developing FN; matched pairs were stratified on the basis of the initial setting of care for FN (ie, inpatient, outpatient, home, and other/unknown). FN-related healthcare use and costs, estimated from the UK National Health Service perspective (2010), were tallied for patients through the last chemotherapy cycle. The study included 221 patients with FN and 221 comparison patients with NHL. Inpatient care for the initial FN event involved 76% of patients; outpatient care was provided to 6% of patients, and home care was delivered to 12%. Among patients with FN requiring inpatient care, the mean number of FN events was 1.44 versus 0.13 for comparison patients; the mean number of days in the hospital was 8.0 versus 0.7, respectively.

Inpatient Costs for FN
Among patients with FN requiring hospitalization, FN costs totaled $14,538 (£9476), which were divided almost equally between the index cycle in which FN first occurred and the period of postindex cycle care. In contrast, healthcare costs among non-FN controls was $3510 (£2288), for a difference of $11,028 (£7188), Dr Weycker reported. "Cost of care subsequent to initial hospitalization accounted for 27% of the difference in FN-related healthcare costs," Dr Weycker noted. The difference in costs between patients with FN requiring outpatient or home care and their matched controls was $2415 (£1574). The cost of care subsequent to initial hospitalization (the difference in postindex cycle cost between patients with FN and controls) accounted for 79% of the difference in FN-related healthcare costs. "Follow-up care is an important component of the economic burden, particularly in the outpatient/home care settings, where costs in the index cycle account for only about 10% of the total FN cost," he said. "We need additional research to ascertain whether some patients treated on an inpatient basis may be candidates for outpatient or home care, where the cost of services may be lower," he added.