Resource Use and Costs Associated with Routine Management of Febrile Neutropenia in German Hospitals.

Febrile neutropenia (FN) is the most frequent dose-limiting complication of myelosuppressive chemotherapy. To date little data is available on the economic consequences of FN management in Germany. Therefore resource use and costs associated with routine FN management were assessed. This was a prospective, multi-centre, observational, longitudinal cost-of-illness study. Patients were enrolled consecutively from 1/2005-12/2006 at the start of first or second line (immuno)chemotherapy (CT) treatment in 4 German hospitals. Patients receiving myeloablative chemotherapy with peripheral blood stem cells were excluded. Adverse drug reactions were monitored prospectively according to the NCI CTCAE v.3.0 and WHO causality criteria. FN was defined as fever above 38°C associated with an absolute neutrophile count <1x10⁹/L. In case of non-availability of the nadir-ANC in daily clinical practice the occurrence of febrile leukopenia (FL) was assessed as leukocyte count <2x10⁹/L and fever above 38°C. Clinical data and resource use were collected from pre-planned chart reviews. German tariffs & prices in €2007 and hospital databases were used to allocate costs to health care resources. Costs are presented from the provider perspective. 325 patients undergoing a total of 1285 chemotherapy cycles were evaluable. 68 episodes of FN/FL (FN: n=28; FL: n=40) occurred in 58 pts. (18%). 35 FN/FL pts. had lymphoma (54% treated with a CHOP-like CT), 9 NSCLC (80% treated with a platinum-based CT) and 14 breast cancer (100% treated with an adjuvant taxane- or anthracyline-based CT). Mean age was 58.1 years (SD 14.5); age≥65 years 38%; female 57%; ECOG≥2 10%. The table shows a comparison of FN/FL patient characteristics with all patients included. 55 FN/FL episodes (81%) were associated with at least one hospital stay (episodes with inpatient treatment: n=49, outpatient or day care: n=6). 5 episodes were treated in an intensive care unit. Mean length of inpatient stay was 8.9 (SD 5.9) days. In addition to concomitant drug use transfusions were necessary in n=15 episodes. Mean treatment cost per FN/FL episode requiring hospital treatment amounted to €3,950 SD 4,961 (range: €134–31,924) with highest mean cost for patients with lymphoma (€4,808). Hospital basic services and personnel accounted for 60% of the direct costs, followed by expenses for drugs (19%) and diagnostics (11%). In conclusion FN/FL induces significant resource use and associated cost. The main cost drivers are hospital basic services and staff. In lymphoma patients FN/FL is more costly than in NSCLC or breast cancer patients.