Management of Febrile Neutropenia - a German Prospective Hospital Cost Analysis in Lymphoproliferative Disorders, Non-Small Cell Lung Cancer, and Primary Breast Cancer

Background: Febrile neutropenia/leukopenia (FN/FL) is the most
frequent dose-limiting toxicity of myelosuppressive chemotherapy,
but German data on economic consequences are limited. Patients and
Methods: A prospective, multicentre, longitudinal, observational
study was carried out to evaluate the occurrence of FN/FL and its
impact on health resource utilization and costs in non-small cell
lung cancer (NSCLC), lymphoproliferative disorder (LPD), and
primary breast cancer (PBC) patients. Costs are presented from a
hospital perspective. Results: A total of 325 consecutive patients
(47% LPD, 37% NSCLC, 16% PBC; 46% women; 38% age >= 65 years)
with 68 FN/FL episodes were evaluated. FN/FL occurred in 22% of the
LPD patients, 8% of the NSCLC patients, and 27% of the PBC
patients. 55 FN/FL episodes were associated with at least 1
hospital stay (LPD n = 34, NSCLC n = 10, PBC n = 11). Mean (median)
cost per FN/FL episode requiring hospital care amounted to (sic)
3,950 ((sic) 2,355) and varied between (sic) 4,808 ((sic) 3,056)
for LPD, (sic) 3,627 ((sic) 2,255) for NSCLC, and (sic) 1,827
((sic) 1,969) for PBC patients. 12 FN/FL episodes (LPD n = 9, NSCLC
n = 3) accounted for 60% of the total expenses. Main cost drivers
were hospitalization and drugs (60 and 19% of the total costs).
Conclusions: FN/FL treatment has economic relevance for hospitals.
Costs vary between tumour types, being significantly higher for LPD
compared to PBC patients. The impact of clinical characteristics on
asymmetrically distributed costs needs further evaluation.