Cost of febrile neutropenia management in cancer patients in Spain

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6089-6089 ◽  
Author(s):  
J. I. Mayordomo ◽  
A. López ◽  
N. Viñolas ◽  
J. Castellanos ◽  
S. Pernas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Chart Review ◽  
P Value ◽  
Bonferroni Correction ◽  
Ct Dose ◽  
Potential Impact ◽  
Common Clinical Practice ◽  
One Way Anova

6089 Background: Febrile neutropenia (FN), a dose-limiting event for many myelosuppressive chemotherapy (CT) regimens, often causes subsequent CT dose delays (DD) and reductions (DR), lengthens hospital stay and increases monitoring, diagnostic and treatment costs. No studies are known to date on economic costs of FN in common clinical practice in Spain. Methods: This is a multicentre, retrospective, observational chart review of adult patients with breast cancer, lung cancer or non-Hodgkin’s lymphoma (NHL) who suffered from at least one FN episode related to cytotoxic CT from 16 Spanish hospitals. Resource use and subsequent costs including days of hospitalization, number of RBC transfusions, number and type of complementary tests, use of colony-stimulating factors (CSF), antibiotics and other drugs to manage FN were assessed. Potential impact of FN on planned CT dose and/or schedule was also analysed. P-value was obtained by one-way ANOVA using the Bonferroni correction. Results: A total of 194 medical charts including 238 documented FN episodes were reviewed. Women, 59.8%; age > 60 yrs, 49.5%; breast cancer, 43% (83% treated with taxane or anthracycline-based CT); lung cancer, 22% (95.5% treated with platinum-based CT); NHL, 35% (58.2% treated with CHOP-like CT). Hospitalization due to FN lasted a median of 7 days. During the episode, 32.3% of pts needed 1 or more RBC transfusions, 97.9% required a blood test and 87% a blood culture. CSFs were used in 67.6% of pts. All pts were treated with antibiotics and 78.2% with other drugs. 58.4% of FN episodes had an impact on planned CT dose and/or schedule: DR was observed in 34.9% of cases, DD in 28% and CT withdrawal in 14.7%. Conclusions: Main drivers of cost of FN are hospitalization and antibiotic treatment. FN is more costly in NHL pts than breast or lung pts (statistically significant in lung pts). FN episodes have a relevant impact on planned CT dose and/or schedule. In each row statistically significant differences ( p<0.05) were obtained between values with the same letter. [Table: see text] [Table: see text]

Febrile Neutropenia in Lymphoma Patients Is Associated with Substantial Resource Use and Healthcare Costs in Clinical Practice in Spain.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5512-5512 ◽  
Author(s):  
A. López ◽  
J.D. Alonso ◽  
J. Gómez-Codina ◽  
A. Novo ◽  
C. Herrera ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Febrile Neutropenia ◽  
Resource Use ◽  
Healthcare Costs ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Substantial Impact ◽  
Ct Dose ◽  
Common Clinical Practice ◽  
The Impact

Abstract Background Despite the significant impact of chemotherapy-induced febrile neutropenia (FN) on patients (pts) with cancer and its consequences for health care costs, there have been no studies in common clinical practice in Spain assessing the burden and economic impact of this complication. Methods This is a sub-analysis of lymphoma pts included in a multicentre, retrospective, chart review of adult pts from 16 Spanish hospitals who suffered from at least one FN episode related to cytotoxic chemotherapy (CT). Resource use and subsequent costs including days of hospitalization, number of transfusions, number and type of complementary tests, use of colony-stimulating factors (CSFs), and use of antibiotics and other drugs to manage FN were assessed for each episode. The impact of FN on planned CT was also analysed in terms of dose delays (DD) and/or reductions (DR). Results Medical charts from 194 pts were reviewed, 67 (34.5%) of whom had lymphoma, which accounted for 87 documented FN episodes included in this analysis. The median (range) age of patients was 62 (19–85) years, 31.7% had aggressive NHL, and 58.2% were treated with CHOP-like CT. FN appeared during first CT cycle in 61.2% of the pts. Hospitalization was required in 100% of the pts and the median length of hospital stay due to FN was 8 days (p25:6–p75:11). During an FN episode, 42% of pts required ≥1 transfusion, 100% needed a blood test and 98.9% a blood culture. Microbiologically documented infection appeared in 33% of FN episodes. All pts were treated with antibiotics (69.3% with cephalosporins) and CSFs were used in 64.8% of pts. In 40.9% of episodes, FN impacted on planned CT dose and/or schedule: DR was observed in 16.7% of pts, DD in 24.0% and CT withdrawal in 15.2%. Conclusions FN has a substantial impact on resource use and associated costs in pts with lymphoma. Hospitalization and antibiotic treatment were the main drivers of the cost associated with the management of FN in current clinical practice. Furthermore, FN has a meaningful effect on planned CT dose and/or schedule, with potential consequences for treatment outcome. Mean (SD) healthcare costs per FN episode (All cost data expressed as €) Hospitalization Transfusions Complementary Tests CSFs Antibiotics and Other Drugs Total 3,557.17 (3,050.44) 43.24 (58.59) 162.77 (135.36) 223.39(231.40) 527.67 (448.56) 4,514.24 (3,392.20)

scholarly journals Higher Mortality Rates in Breast and Lung Cancer Patients Admitted for Febrile Neutropenia: An Analysis of Outcomes Based on Data from the Nationwide Inpatient Sample from 2006-2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5904-5904
Author(s):  
Ankit Shah ◽  
Stuthi Perimbeti ◽  
Sumera Bukhari ◽  
Michael Wismer ◽  
Jordan Senchak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Mortality Rates ◽  
Primary Diagnosis ◽  
Lung Cancer Patients ◽  
Total Charges

Abstract Background: Febrile neutropenia is associated with significant morbidity, mortality, healthcare resource utilization and associated cost. However, data regarding the relationship of specific cancers with admission for febrile neutropenia and their outcomes is lacking. Methods: Using the ICD-9 codes 288.00 and 288.04, we identified all adult admissions with primary diagnosis of febrile neutropenia during the interval of 2006-2013 from the Nationwide Inpatient Sample (NIS). Hospitalization information regarding mortality rates, length of stay and total charges was extracted for each year. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Differences in these variables in teaching and nonteaching institutions were evaluated. ICD-9 codes for esophageal, colon, rectal, liver, pancreatic, bladder, prostate, cervical, renal, thyroid, lung, and melanoma skin cancers were selected and the percentage of admissions attributed to each malignancy was determined. Results: We identified 48,253 admissions (weighted N = 233,116) with a primary diagnosis of febrile neutropenia from 2006-2013. Most of these admissions occurred at teaching institutions (n=28,902, weighted n=139,574). In-hospital mortality rates for febrile neutropenia had a downward trend over the time period of 2006-2013 although the difference was not statistically significant (p=.082). Specifically, the in-hospital mortality rate was 2.73% in 2006 and 1.35% in 2013. Mean length of stay (days) has decreased from 5.67 (±.16) in 2006 to 5.32 (±0.06) in 2013 (p=.0001) while total charges have increased from $29,113 (±1089) in 2006 to $41,713 (±726) in 2013 (p=.0001). This is greater than the expected inflationary change from $29,133 to $33,641 over the same time period. Mean length of stay (days) was found to be higher at teaching (5.89±.03) than at non-teaching (5.25±.04) hospitals (p=.0001). Similarly, mean total charges were higher in teaching ($41,577±364) than in non-teaching ($34,176±345) institutions (p=.0001). When comparing teaching vs. non-teaching institutions, in-hospital mortality was not found to have a statistically significant difference (p=.2688). Of the 13 malignancies queried, lung cancer (11.06%) and breast cancer (8.40%) accounted for more admissions for febrile neutropenia than the other malignancies selected. Breast cancer (3.62%, p=.0001) and lung cancer (16.11%, p=.0001) were also associated with much higher in-hospital mortality rates compared with the other malignancies selected. Conclusions: Breast and lung cancer account for a significant number of admissions for febrile neutropenia, which is consistent with their national prevalence. Of particular note,breast and lung cancer patients who were admitted for febrile neutropenia had a higher risk of mortality. In lung cancer, the frequently associated smoking-related comorbidities may be contributing to this finding. While in breast cancer, patients with advanced disease have an increase in cumulative lifetime dose of chemotherapy due to prolonged survival and this may result in a weakened bone marrow, a more susceptible patient, and consequently an increase in febrile neutropenia and mortality rates. Thus, given the greater mortality rate and significant number of patients affected, patients with these two malignancies should receive special attention to ensure they receive prophylaxis with granulocyte stimulating agents and/or antibiotics after treatment with cytotoxic chemotherapy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

A Retrospective Review of Engraftment Data for Tbo-Filgrastim Vs. Filgrastim in Patients Undergoing High Dose Chemotherapy and Autologous Stem Cell Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5484-5484
Author(s):  
Taylor Teschner ◽  
Stephen Lo ◽  
Dina Brauneis ◽  
Anthony C Shelton ◽  
Bhavesh Shah ◽  
...  
Keyword(s):  
Stem Cell ◽  
Febrile Neutropenia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Chart Review ◽  
Median Number ◽  
High Dose Chemotherapy ◽  
P Value ◽  
High Dose ◽  
Neutrophil Engraftment

Abstract Background: Patients undergoing high dose chemotherapy and autologous stem cell transplantation (HDC/SCT) have received Filgrastim from day +1 through neutrophil engraftment as per institutional guidelines. Recombinant Flgrastim (Tbo-Filgrastim) has not been compared with Filgrastim post SCT for kinetics of engraftment after high dose chemotherapy and stem cell transplantation. Tbo-Filgrastim was introduced in April 2014 at our center and is currently used only in the inpatient setting after HDC/SCT; while the use of Filgrastim is exclusive in the outpatient setting after HDC/SCT. Currently Tbo-Filgrastim is not approved as a biosimilar in the US (only indicated for reduction in the duration of severe neutropenia in patients with non-myeloid malignancies) and does not carry an "interchangeability" designation. Objective: To review neutrophil and platelet engraftment data for patients who received Tbo-Filgrastim compared to patients who received Filgrastim after HDC/SCT. Methods: A comprehensive chart review was conducted on 34 patients from Sept 2013 to May 2015: 17 patients received Tbo-Filgrastim and 17 patients received Filgrastim after SCT. All discharge summaries and electronic medical records were reviewed for inpatient and outpatient status and engraftment data. A Wilcoxon rank sum test was conducted to compare the median time to engraftment for patients who received Tbo-Filgrastim vs. Filgrastim due to the non-parametric nature of the data. A Chi-Square test was done to compare proportions of patients that had febrile neutropenia. Subjects who did not receive Tbo-Filgrastim as an inpatient after the institution switch (n=3) were excluded from analyses. Results: Table 1. Tbo-Filgrastim (n=17) Filgrastim (n=17) Time period 4/2014-5/2015 9/2013 -3/2014 Disease Type AL Amyloidosis 10 (59%) 14 (82%) Myeloma 6 (35%) 2 (12%) Lymphoma 1 (6%) 1 (6%) Median Age, years (range) 57 (41-72) 54 (41-68) Male 11 (65%) 10 (59%) Female 6 (35%) 7 (41%) Mobilization Regimen G-CSF 7 (41%) 13 (76%) Chemo + GCSF 3 (18%) 1 (6%) G-CSF + Plerixafor 6 (35%) 2 (12%) Preparative Regimen Melphalan @ 200mg/m2 10 (59%) 13 (76%) Melphalan @ 140mg/m2 6 (35%) 3 (18%) CBV 1 (6%) 1 (6%) Median number of stem cell collection; 106 CD 34+/kg (range) 13.9 (1.8- 21.8) 9.1 (3.9- 16.6) Median number of stem cells reinfusion; 106 CD 34+/kg (range) 8.4 (3.0-17.4) 6.9 (3.5-10.5) Febrile Neutropenia 10 (59%) 8 (47%) p value=0.73 Median days to neutrophil engraftment (range) 11 (9-14) 10 (8-15) p value=0.07 Median days to platelet engraftment (range) 12 (10-21) 12 (9-27) p value=0.49 Median days of growth factor, (range) 6 (3-10) 10 (8-15) Death 0 1 Conclusions: In this retrospective chart review, we did not find any significant difference in time to neutrophil engraftment after HDC/SCT when comparing patients who received Filgrastim and then switched to Tbo-Filgrastim after SCT. Even though Tbo-Filgrastim is not approved as a biosimilar and lacks interchangeability designation, based on our experience the safety, efficacy and immunogenicity is comparable to Filgrastim and there are no clinical meaningful differences between the two products. However, this data warrants further prospective research with a larger sample size to confirm these findings. Disclosures No relevant conflicts of interest to declare.

How oncologists adhere to evidence-based G-CSF-guidelines to prevent febrile neutropenia: A sample survey in hospitals and practices in Germany.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6591-6591 ◽  
Author(s):  
Hartmut Link ◽  
Josef Nietsch ◽  
Markus Kerkmann ◽  
Petra Angelika Ortner ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Sample Size ◽  
Malignant Lymphoma ◽  
Sample Survey ◽  
Evidence Based ◽  
Intermediate Risk ◽  
Evidence Based Guidelines

6591 Background: Primary G-CSF prophylaxis after chemotherapy is recommended in evidence based guidelines (GL), if the risk of febrile neutropenia (FN) is high (≥20%), or intermediate (≥ 10% - 20%) in case of risk factors. The aim was to evaluate, if G-CSF is used as proposed by GL, to identify determinants of GL implementation and adherence. Methods: The sample size was calculated at 2% of the incidence of malignant lymphoma, breast and lung cancer in Germany. Pts who had received 3-9 cycles of chemotherapy with a FN risk ≥10% between 5/2011 to 4/2012 were documented retrospectively. Results: 286 lymphoma, 666 lung cancer and 976 breast cancer pts were collected from 87 hospitals and 59 oncology practices with 195 physicians participating. Adherence to GL was higher in physicians up to 10 than over 10 years of experience. Conclusions: The adherence to and acceptance of GL for G-CSF may not be sufficient. Patient risk factors are underestimated therefore resulting in a possible underuse of G-CSF. Physicians may underestimate FN risk in pts who have an intermediate risk of FN and they overestimate their adherence to the GL. [Table: see text]

Febrile neutropenia and mortality in patients with breast cancer, lung cancer, and non-Hodgkin lymphoma.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 6604-6604
Author(s):  
Aniket A Kawatkar ◽  
Chun Chao ◽  
Wansu Chen ◽  
Richard L. Barron ◽  
Hairong Xu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Hodgkin Lymphoma ◽  
Non Hodgkin Lymphoma

Women screened for breast cancer are dying from lung cancer: An opportunity to improve lung cancer screening in a mammography population

2021 ◽  
pp. 096914132110130
Author(s):  
Kim L Sandler ◽  
Diane N Haddad ◽  
Alexis B Paulson ◽  
Travis J Osterman ◽  
Carolyn C Scott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Natural Language Processing ◽  
Cancer Screening ◽  
Natural Language ◽  
Language Processing ◽  
Chart Review ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Lung Screening

Objective Lung cancer is the leading cancer killer in women, resulting in more deaths than breast, cervical and ovarian cancer combined. Screening for lung cancer has been shown to significantly reduce mortality, with some evidence that women may have a greater benefit. This study demonstrates that a population of women being screened for breast cancer may greatly benefit from screening for lung cancer. Methods Data from 18,040 women who were screened for breast cancer in 2015 at two imaging facilities that also performed lung screening were reviewed. A natural language-processing algorithm followed by a manual chart review identified women eligible for lung cancer screening by U.S. Preventive Services Task Force (USPSTF) criteria. A chart review of these eligible women was performed to determine subsequent enrollment in a lung screening program (2016–2019), current screening eligibility, cancer diagnoses and cancer-related outcomes. Results Natural language processing identified 685 women undergoing screening mammography who were also potentially eligible for lung screening based on age and smoking history. Manual chart review confirmed 251 were eligible under USPSTF criteria. By June 2019, 63 (25%) had enrolled in lung screening, of which three were diagnosed with screening-detected lung cancer resulting in zero deaths. Of 188 not screened, seven were diagnosed with lung cancer resulting in five deaths by study end. Four women received a diagnosis of breast cancer with no deaths. Conclusion Women screened for breast cancer are dying from lung cancer. We must capitalize on reducing barriers to improve screening for lung cancer among high-risk women.

Incidence of Febrile Neutropenia and Myelotoxicity of Chemotherapy: A Meta-Analysis of Biosimilar G-CSF Studies in Breast Cancer, Lung Cancer, and Non-Hodgkin’s Lymphoma

Onkologie ◽  
2009 ◽  
Vol 32 (10) ◽  
pp. 599-604 ◽  
Author(s):  
Andreas Engert ◽  
Auro del Giglio ◽  
Peter Bias ◽  
Heinz Lubenau ◽  
Ulrich Gatzemeier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Meta Analysis

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

Onkologie ◽  
2011 ◽  
Vol 34 (5) ◽  
pp. 241-246 ◽  
Author(s):  
Angela Ihbe-Heffinger ◽  
Bernadette J. Paessens ◽  
Christoph von Schilling ◽  
Margarita Shlaen ◽  
Nina Gottschalk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Cost Analysis ◽  
Small Cell Lung Cancer ◽  
Primary Breast Cancer ◽  
Hospital Cost ◽  
Small Cell ◽  
Lymphoproliferative Disorders ◽  
Small Cell Lung

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

2019 ◽  
Vol 28 (1) ◽  
pp. 113-122 ◽  
Author(s):  
Shuling Li ◽  
Jiannong Liu ◽  
Charles Bowers ◽  
Tamer A. F. S. Garawin ◽  
Christopher Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
Non Hodgkin Lymphoma

Efektifitas Ekstrak Daun Sirih Hijau (Piper Betle) sebagai Insektisida Nabati terhadap Mortalitas Lalat Rumah (Musca domestica)

2019 ◽  
Vol 10 (2) ◽  
pp. 44-50
Author(s):  
Rinaldi Daswito ◽  
Rima Folentia ◽  
M Yusuf MF
Keyword(s):  
Musca Domestica ◽  
Leaf Extract ◽  
Effective Concentration ◽  
P Value ◽  
Piper Betle ◽  
Microbiology Laboratory ◽  
House Flies ◽  
Betel Leaf ◽  
The One ◽  
One Way Anova

One of the diseases that can be transmitted by flies is diarrhea. Green betel leaf contains essential oils, chavicol, arecoline, phenol, and tannins which function as plant-based insecticides. This study aimed to determine the effectiveness of green betel leaf extract (Piper betel) as a plant-based insecticide on the number of mortality of house flies (Musca domestica). The research was an experimental study used After Only Design used the One Way Anova test with a 95% confidence level. The samples used were 360 ​​house flies. Each treatment of 30 house flies with 4 repetitions and used three concentrations of green betel leaf extract (25%, 50%, 75%). The study was conducted at the Chemistry and Microbiology Laboratory of Health Polytechnic Tanjungpinang, while the location of the fly collection was at the Tokojo Garbage Collection Station in Bintan Regency. The number of mortality of house flies at a concentration of 25% was 81 heads (67.5%), 50% concentrations were 93 heads (77.5%), and at a concentration of 75% were 103 heads (85.83%). There was an effect of green betel leaf extract on the mortality of house flies (p-value 0.0001 <0.05) with the most effective concentration of 75%. Further research is needed to obtain a finished product utilizing green betel leaf extract as a vegetable insecticide, especially in controlling the fly vector. Need further research on the use of green betel leaf extract as a vegetable insecticide controlling the fly vector by taking into account the amount of spraying and the age of the fly.   Keywords: Green betel leaf extract , organic insecticide, houseflies

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