title: Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yvonne Peijun
authors.initials: YP
authors.lastname: Zhou
authors.forename: Jing
authors.initials: J
authors.lastname: Jin
authors.forename: Ying
authors.initials: Y
authors.lastname: Ding
authors.forename: Yen Lin
authors.initials: YL
authors.lastname: Chee
authors.forename: Liang Piu
authors.initials: LP
authors.lastname: Koh
authors.forename: Wee Joo
authors.initials: WJ
authors.lastname: Chng
authors.forename: Douglas Su-Gin
authors.initials: DS
authors.lastname: Chan
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D015331:Cohort Studies; D064147:Febrile Neutropenia / Q000191:economics* / Q000209:etiology / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006402:Hematologic Diseases / Q000150:complications* / Q000191:economics* / Q000628:therapy; D019337:Hematologic Neoplasms / Q000150:complications / Q000191:economics / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012846:Singapore