Cost of Neutropenia in Patients With Breast Cancer
Cost of Neutropenia in Patients With Breast Cancer
Study Objective. To estimate the economic burden of neutropenia and febrile neutropenia in female breast cancer hospital admissions in the United States.
Design. Retrospective database analysis.
Patients. Female admissions with a breast cancer diagnosis.
Measurements and Main Results. By reviewing two national databases (Healthcare Costs and Utilization Project, MarketScan), length of stay and charge or payment/admission were estimated from 1994-1996. Neutropenic and febrile neutropenic admissions were longer and incurred higher charges and payments than nonneutropenic and afebrile neutropenic admissions, respectively (p<0.05). The difference in mean charges between neutropenic and nonneutropenic admissions decreased from $13,143 in 1994 to $6913 in 1996, whereas the difference in payment was $4957 (adjusted to 1996 dollars). The difference in mean charges between febrile and afebrile neutropenic admissions decreased from $11,570 in 1994 to $2873 in 1996, whereas the difference in payment was $2390 (adjusted to 1996 dollars).
Conclusion. There was a trend toward decreased charges for inpatient admissions with neutropenia in patients with breast cancer (1994-1996). Interventions that reduce the frequency of neutropenia and febrile neutropenia could reduce hospitalization costs of breast cancer admissions.
The incidence of breast cancer has increased in recent decades. In the United States alone, the age-adjusted incidence of female breast cancer increased from 88.1/100,000 cases in 1975 to 110.7/100,000 cases in 1996. Over the same period, the age-adjusted incidence of breast cancer in women older than 50 years increased from 267.4 to 355.8/100,000 cases. Although the incidence of breast cancer increased, survival rates improved. Between 1975 and 1996, the breast cancer mortality rate among all U.S. women decreased from 27.6 to 24.2/100,000 deaths, and among women over age 50 years, mortality decreased dramatically from 91.8 to 83.7/100,000. Much of the improvement is due to early diagnosis and treatment advances such as multimodal therapy using surgery (e.g., breast conserving mastectomy), radiation, cytotoxic chemotherapy, hormone therapy (e.g., tamoxifen), and/or immunotherapy (e.g., monoclonal antibodies).
Cytotoxic chemotherapy causes neutropenia, one of the most severe treatment-related toxicities. Neutropenia is a dose-dependent side effect and poses serious complications for patients with any cancer that requires treatment with cytotoxic chemotherapy. The monitoring and treatment of neutropenia place an economic burden, beyond that of the cancer, on both patients and the health care system. Treatment of neutropenia may require hospital-ization, empiric treatment with expensive antibiotics, and isolation in an intensive care setting.
Despite the high incidence of breast cancer and the complexity of managing treatment-induced neutropenia, characterization of the burden of neutropenia in patients with breast cancer is limited. Existing studies have identified the major cost components such as hospitalizations, antibiotic therapy, physician and nonphysician fees, laboratory costs, and indirect costs of lost productivity. However, few studies have reported the economic impact of neutropenia in patients with breast cancer. Therefore, we compared the charges and payments associated with inpatient admissions with and without neutropenia among women with breast cancer in the U.S. We also compared charges and payments associated with febrile and afebrile neutropenic admissions in this population.
Study Objective. To estimate the economic burden of neutropenia and febrile neutropenia in female breast cancer hospital admissions in the United States.
Design. Retrospective database analysis.
Patients. Female admissions with a breast cancer diagnosis.
Measurements and Main Results. By reviewing two national databases (Healthcare Costs and Utilization Project, MarketScan), length of stay and charge or payment/admission were estimated from 1994-1996. Neutropenic and febrile neutropenic admissions were longer and incurred higher charges and payments than nonneutropenic and afebrile neutropenic admissions, respectively (p<0.05). The difference in mean charges between neutropenic and nonneutropenic admissions decreased from $13,143 in 1994 to $6913 in 1996, whereas the difference in payment was $4957 (adjusted to 1996 dollars). The difference in mean charges between febrile and afebrile neutropenic admissions decreased from $11,570 in 1994 to $2873 in 1996, whereas the difference in payment was $2390 (adjusted to 1996 dollars).
Conclusion. There was a trend toward decreased charges for inpatient admissions with neutropenia in patients with breast cancer (1994-1996). Interventions that reduce the frequency of neutropenia and febrile neutropenia could reduce hospitalization costs of breast cancer admissions.
The incidence of breast cancer has increased in recent decades. In the United States alone, the age-adjusted incidence of female breast cancer increased from 88.1/100,000 cases in 1975 to 110.7/100,000 cases in 1996. Over the same period, the age-adjusted incidence of breast cancer in women older than 50 years increased from 267.4 to 355.8/100,000 cases. Although the incidence of breast cancer increased, survival rates improved. Between 1975 and 1996, the breast cancer mortality rate among all U.S. women decreased from 27.6 to 24.2/100,000 deaths, and among women over age 50 years, mortality decreased dramatically from 91.8 to 83.7/100,000. Much of the improvement is due to early diagnosis and treatment advances such as multimodal therapy using surgery (e.g., breast conserving mastectomy), radiation, cytotoxic chemotherapy, hormone therapy (e.g., tamoxifen), and/or immunotherapy (e.g., monoclonal antibodies).
Cytotoxic chemotherapy causes neutropenia, one of the most severe treatment-related toxicities. Neutropenia is a dose-dependent side effect and poses serious complications for patients with any cancer that requires treatment with cytotoxic chemotherapy. The monitoring and treatment of neutropenia place an economic burden, beyond that of the cancer, on both patients and the health care system. Treatment of neutropenia may require hospital-ization, empiric treatment with expensive antibiotics, and isolation in an intensive care setting.
Despite the high incidence of breast cancer and the complexity of managing treatment-induced neutropenia, characterization of the burden of neutropenia in patients with breast cancer is limited. Existing studies have identified the major cost components such as hospitalizations, antibiotic therapy, physician and nonphysician fees, laboratory costs, and indirect costs of lost productivity. However, few studies have reported the economic impact of neutropenia in patients with breast cancer. Therefore, we compared the charges and payments associated with inpatient admissions with and without neutropenia among women with breast cancer in the U.S. We also compared charges and payments associated with febrile and afebrile neutropenic admissions in this population.
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