title: Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain.
abstract: BACKGROUND
  Febrile neutropenia (FN) is associated with disruption of planned chemotherapy and increased management costs. However, the economic impact of FN in Spanish clinical practice has not been documented hitherto.
  
  
  METHODS
  A multicenter, retrospective chart review of adults with breast or lung cancer or non-Hodgkin's lymphoma (NHL) who had > or = 1 FN episode during chemotherapy. Resource use, direct costs, and FN effect on planned chemotherapy were assessed.
  
  
  METHODS
  238 episodes of FN were analyzed in 194 patients. The mean + or - SD length of FN-related hospitalization was 8.7 + or - 6.9 days (median [p(25)-p(75)] = 7 [5-11] days). At least one transfusion was needed in 77 (32.3%) FN episodes, blood tests were done in 233 (97.9%) and blood cultures in 207 (87.0%). Antibiotics were used in all episodes (100%), other drugs in 186 (78.2%) episodes and the granulocyte colony-stimulating factor (G-CSF) in 161 (67.7%) episodes. The distribution of costs per episode of FN were: hospitalization 79%, antibiotics 10%, G-CSF 5%, complementary tests 4%; other drugs 1%, blood transfusions 1%. The estimated mean (95% CI) cost per FN episode was euro3841 (95% CI: euro3476-4206). FN management was costlier in NHL patients euro4514 (95% CI: euro3805-5223) than in breast or lung cancer patients (euro3519 [95% CI: euro2976-4061] and euro3311 [95% CI: euro2817-3805] respectively) (P < 0.05 both comparisons). Planned chemotherapy was disrupted in 139 (58.4%) episodes (dose reductions in 75 [34.9%], dose delays in 60 [28.0%] and withdrawal in 33 [14.7%]).
  
  
  CONCLUSIONS
  FN substantially affects healthcare resource use and costs in breast cancer, lung cancer and, NHL. In this study, hospitalization and antibiotics were the main drivers of cost. A limitation of the analysis was that it did not include the indirect costs associated with FN episodes.
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, E-50009 Zaragoza, Spain. josemayordomo@hotmail.com
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Mayordomo
authors.forename: Andrés
authors.initials: A
authors.lastname: López
authors.forename: Núria
authors.initials: N
authors.lastname: Viñolas
authors.forename: Javier
authors.initials: J
authors.lastname: Castellanos
authors.forename: Sonia
authors.initials: S
authors.lastname: Pernas
authors.forename: Juan
authors.initials: J
authors.lastname: Domingo Alonso
authors.forename: Adolfo
authors.initials: A
authors.lastname: Frau
authors.forename: Miquel
authors.initials: M
authors.lastname: Layola
authors.forename: José
authors.initials: J
authors.lastname: Antonio Gasquet
authors.forename: Jordi
authors.initials: J
authors.lastname: Sánchez
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000191:economics*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000191:economics*; D012189:Retrospective Studies; D013030:Spain
chemical_list: D000970:Antineoplastic Agents