• José Ignacio Mayordomo, Andrés López, Núria Viñolas, Javier Castellanos, Sonia Pernas, Juan Domingo Alonso, Adolfo Frau, Miquel Layola, José Antonio Gasquet, Jordi Sánchez, and ENIA Study Group.
• Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco 15, E-50009 Zaragoza, Spain. josemayordomo@hotmail.com
• Curr Med Res Opin. 2009 Oct 1; 25 (10): 2533-42.

BackgroundFebrile neutropenia (FN) is associated with disruption of planned chemotherapy and increased management costs. However, the economic impact of FN in Spanish clinical practice has not been documented hitherto.Research Design And MethodsA multicenter, retrospective chart review of adults with breast or lung cancer or non-Hodgkin's lymphoma (NHL) who had > or = 1 FN episode during chemotherapy. Resource use, direct costs, and FN effect on planned chemotherapy were assessed.Main Outcome Measures238 episodes of FN were analyzed in 194 patients. The mean + or - SD length of FN-related hospitalization was 8.7 + or - 6.9 days (median [p(25)-p(75)] = 7 [5-11] days). At least one transfusion was needed in 77 (32.3%) FN episodes, blood tests were done in 233 (97.9%) and blood cultures in 207 (87.0%). Antibiotics were used in all episodes (100%), other drugs in 186 (78.2%) episodes and the granulocyte colony-stimulating factor (G-CSF) in 161 (67.7%) episodes. The distribution of costs per episode of FN were: hospitalization 79%, antibiotics 10%, G-CSF 5%, complementary tests 4%; other drugs 1%, blood transfusions 1%. The estimated mean (95% CI) cost per FN episode was euro3841 (95% CI: euro3476-4206). FN management was costlier in NHL patients euro4514 (95% CI: euro3805-5223) than in breast or lung cancer patients (euro3519 [95% CI: euro2976-4061] and euro3311 [95% CI: euro2817-3805] respectively) (P < 0.05 both comparisons). Planned chemotherapy was disrupted in 139 (58.4%) episodes (dose reductions in 75 [34.9%], dose delays in 60 [28.0%] and withdrawal in 33 [14.7%]).ConclusionsFN substantially affects healthcare resource use and costs in breast cancer, lung cancer and, NHL. In this study, hospitalization and antibiotics were the main drivers of cost. A limitation of the analysis was that it did not include the indirect costs associated with FN episodes.

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