title: Hospitalizations, outcomes, and management costs of febrile neutropenia in patients from a managed care population.
abstract: The study objective was to evaluate chemotherapy treatment patterns and incidence, cost, and resource utilization of febrile neutropenia-related hospitalization (FNH) in patients with breast cancer, lung cancer, and non-Hodgkin's lymphoma (NHL) from Kaiser Permanente Southern California (KPSC), a large integrated delivery system.
  
  
  
  Adults ≥18 years with any stage breast cancer, lung cancer, or NHL who initiated myelosuppressive chemotherapy from 01/01/2006 to 12/31/2009 were included. Chemotherapy dose delays ≥7 days, relative dose intensity (RDI), regimen switching, FNH and all-cause mortality, granulocyte colony-stimulating factor (G-CSF) and antibiotic use, and healthcare utilization/cost were evaluated by cancer type, regimen, and/or cycle.
  
  
  
  Among 3314 breast cancer patients, 25.3% received an RDI ≤85%, 13.9% experienced FNH with an all-cause mortality rate of 2.0%, and 20.2% received primary prophylaxis with G-CSF. Among those with FNH, mean hospital length of stay (LOS) was 4.1 days, and mean total costs were $20,462. Among 1443 lung cancer patients, 17.9% had an RDI ≤85%, 8.0% experienced FNH with an all-cause mortality rate of 25.2%, and 4.5% received primary prophylaxis with G-CSF. Among those with FNH, mean LOS was 6.8 days, and mean total costs were $32,964. Among 581 NHL patients, 27.9% had an RDI ≤85% and 22.4% experienced FNH with an all-cause mortality rate of 13%. Among those with FNH, mean LOS was 7.9 days, and mean total costs were $37,555.
  
  
  
  Marked variability was observed among different cancer types and chemotherapy regimens. Given the variability, detailed insight into incidence, management, and burden of FN can help inform clinical decision making.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. Aniket.A.Kawatkar@kp.org.
authors.forename: Aniket A
authors.initials: AA
authors.lastname: Kawatkar
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.|Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Farias
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Chun
authors.initials: C
authors.lastname: Chao
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Wansu
authors.initials: W
authors.lastname: Chen
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Vogl
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Chandler
mesh_terms: D064147:Febrile Neutropenia / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Febrile neutropenia; Healthcare utilization; Outcomes; Relative dose intensity