title: Costs associated with febrile neutropenia in solid tumor and lymphoma patients - an observational study in Singapore.
abstract: BACKGROUND
  The primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost. The secondary objective was to describe the out-of-pocket patient payments and the factors that were associated with higher out-of-pocket patient payments.
  
  
  METHODS
  This was a single-center observational study conducted at the largest cancer center in Singapore. All of the adult cancer patients hospitalized due to FN from 2009 to 2012 were studied. The primary outcomes were the total hospital cost and the out-of-pocket patient payments (adjusted by government subsidy) per FN episode. Univariate analysis and multiple linear regression were conducted to identify the factors associated with higher FN costs.
  
  
  RESULTS
  Three hundred and sixty seven adult cancer patients were documented with FN-related hospitalizations. The mean total hospital cost was US$4,193 (95% CI: US$3,779-4,607) and the mean out-of-pocket patient payment was US$2,230 (95% CI: US$1,976-2,484), per FN episode. The factors associated with a higher total hospital cost were longer length of stay, severe sepsis, and lymphoma as underlying cancer. The out-of-pocket patient payment was positively associated with longer length of stay, severe sepsis, lymphoma diagnosed as underlying cancer, the therapeutic use of granulocyte colony-stimulating factor (GCSF), the private ward class, and younger patients.
  
  
  CONCLUSIONS
  The total hospital cost and out-of-pocket patient payments of FN management in lymphoma cases were substantial compared with other solid tumors. Factors associated with a higher FN management cost may be useful for developing appropriate strategies to reduce the cost of FN for cancer patients.
authors.forename: Xiao Jun
authors.initials: XJ
authors.lastname: Wang
authors.forename: Mabel
authors.initials: M
authors.lastname: Wong
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore 117543, Singapore. phaac@nus.edu.sg.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D064147:Febrile Neutropenia / Q000191:economics* / Q000209:etiology*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore
chemical_list: D000970:Antineoplastic Agents