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Symptom Management and Supportive Care

Evaluating the Total Costs of Chemotherapy-Induced Febrile Neutropenia: Results from a Pilot Study with Community Oncology Cancer Patients

^aThe Robert H. Lurie Comprehensive Cancer Center and the Division of Hematology/Oncology, Northwestern University, Chicago, Illinois, USA; ^bUniversity of Illinois School of Public Health, Chicago, Illinois, USA

Key Words. Costs • Febrile neutropenia • Chemotherapy • Toxicity

Correspondence: Charles L. Bennett, M.D., Ph.D., Northwestern University, 303 E. Chicago Street, Suite 8250, Chicago, Illinois 60611, USA. Telephone: 312-503-0804; Fax: 312-503-1040; e-mail: cbenne{at}northwestern.edu

Purpose. While cancer chemotherapy–related febrile neutropenia affects patients' activities and medical expenditures, few studies have reported on the total costs of this condition. Here, we evaluate the feasibility of obtaining detailed and comprehensive cost information on patients who experience febrile neutropenia during cancer chemotherapy treatment.

Methods. Community oncology cancer patients who experienced chemotherapy-associated febrile neutropenia recorded information about use of medical care, tests, devices, medications, and lost productivity. Direct cost estimates were derived from Medicare Physician Fee Schedules and cost-to-charge ratios. Indirect cost estimates were based on modified Labor Force, Employment, and Earnings data for employed patients and wages earned by paid caregivers. Multivariate regression models evaluated predictors of higher direct, indirect, and total costs.

Results. Outpatients' mean direct and indirect costs were $5,704 and $1,201 (lymphoma), $1,094 and $1,530 (breast cancer), and $1,329 and $1,325 (lung cancer and myeloma), respectively. The mean direct and indirect costs were three- to tenfold and 1.5- to threefold greater for inpatients, respectively. Factors associated with higher direct costs of care included diagnosis of lymphoma and inpatient care; higher indirect costs, male versus female gender; higher total costs, lymphoma diagnosis and inpatient care.

Conclusion. Estimation of the total costs of cancer-related neutropenia is feasible. Indirect costs appear to account for as much as half of the total supportive care costs when febrile neutropenia is managed in the outpatient setting and about one fifth of the total supportive care costs in the inpatient setting.

Disclosure of potential conflicts of interest is found at the end of this article.

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