title: Cost of chemotherapy-induced thrombocytopenia among patients with lymphoma or solid tumors.
abstract: BACKGROUND
  The purpose of this study was to estimate the mean incremental cost of chemotherapy-induced thrombocytopenia and the drivers of cost. Another goal was to estimate the impact of depth and duration of thrombocytopenia on the cost of thrombocytopenia.
  
  
  METHODS
  A retrospective cohort, consisting of a random sample of 75 solid tumor or lymphoma patients who developed chemotherapy-induced thrombocytopenia (</= 50,000 platelets per microl), was chosen. The number of each type of resource used during 217 cycles with and 300 cycles without thrombocytopenia were multiplied by the cost of each resource and summed to yield the total cost of care (in 1999 dollars from the provider's perspective).
  
  
  RESULTS
  Compared with cycles without thrombocytopenia, the mean incremental cost of thrombocytopenia was $1037 per cycle. However, 60% of cycles were usual cost, with a mean cost of thrombocytopenia of $43 per cycle less than control cycles. Twelve percent of cycles were high cost (mean incremental cost = $612 per cycle); 28% were very high cost (mean incremental cost = $3519). The excess cost during high-cost cycles was due to high consumption of prophylactic platelet transfusions and during very high-cost cycles to both higher platelet transfusion consumption and to a high incidence of major bleeding episodes.
  
  
  CONCLUSIONS
  Although thrombocytopenia is a common complication of chemotherapy, only 40% of cycles with thrombocytopenia would be considered high or very high cost. Interventions targeted at this subset of cycles could significantly reduce the cost of thrombocytopenia provided they are initiated early enough in the chemotherapy experience to be effective.
authors.affiliation: The Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. lelting@mdanderson.org
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.forename: Charles G
authors.initials: CG
authors.lastname: Martin
authors.forename: Lois
authors.initials: L
authors.lastname: Hamblin
authors.forename: Danna
authors.initials: D
authors.lastname: Kurtin
authors.forename: Edgardo
authors.initials: E
authors.lastname: Rivera
authors.forename: Saroj
authors.initials: S
authors.lastname: Vadhan-Raj
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D017713:Platelet Transfusion; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000191:economics*