Febrile neutropenia-related care and associated costs in elderly patients with breast cancer, lung cancer, or non-Hodgkin lymphoma

Support Care Cancer. 2020 Jan;28(1):113-122. doi: 10.1007/s00520-019-04795-0. Epub 2019 Apr 15.

Abstract

Purpose: Limited information is available regarding elderly patients experiencing febrile neutropenia (FN). This study evaluated FN-related care among elderly cancer patients who received high/intermediate FN-risk chemotherapy and experienced ≥ 1 FN episodes.

Methods: We used Medicare data to identify patients aged ≥ 66 years who initiated high/intermediate FN-risk chemotherapy between 1 January 2008 and 31 August 2015 to treat breast cancer (BC), lung cancer (LC), or non-Hodgkin lymphoma (NHL) and had ≥ 1 FN episodes. We identified within-cycle FN episodes for each chemotherapy cycle on Part A inpatient claims or outpatient or Part B claims. We described the FN-related care setting (inpatient hospital, outpatient emergency department [ED], or outpatient non-ED) and reported mean total cost of FN-related care per episode overall and by care setting (adjusted to 2015 US$).

Results: We identified 2138, 3521, and 2862 patients with BC, LC, and NHL, respectively, with ≥ 1 FN episodes (total episodes: 2407, 3840, 3587, respectively). Most FN episodes required inpatient care (BC, 88.1%; LC, 93.0%; NHL, 93.2%) with mean hospital length of stay (LOS) 6.2, 6.5, and 6.8 days, respectively. Intensive care unit admission was required for 20.4% of BC, 29.0% of LC, and 25.7% of NHL hospitalizations (mean LOS: 4.7, 4.7, 5.5 days, respectively). The mean total cost of FN care per episode was $11,959 BC, $14,388 LC, and $15,006 NHL, with inpatient admission the costliest care component ($11,826; $14,294; and $14,873; respectively).

Conclusions: Among elderly patients with BC, LC, or NHL who experienced FN, most FN episodes required costly hospital care, highlighting the FN burden on healthcare systems.

Keywords: Chemotherapy; Elderly patients; Febrile neutropenia; Healthcare costs; Medicare.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / economics
  • Breast Neoplasms / epidemiology
  • Chemotherapy-Induced Febrile Neutropenia / economics*
  • Chemotherapy-Induced Febrile Neutropenia / epidemiology
  • Chemotherapy-Induced Febrile Neutropenia / therapy*
  • Costs and Cost Analysis
  • Female
  • Health Care Costs* / statistics & numerical data
  • Health Services for the Aged / economics
  • Health Services for the Aged / statistics & numerical data
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / economics
  • Lung Neoplasms / epidemiology
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Lymphoma, Non-Hodgkin / economics
  • Lymphoma, Non-Hodgkin / epidemiology
  • Male
  • Medicare / economics
  • Retrospective Studies
  • United States / epidemiology