OBJECTIVES

To evaluate the direct costs from the Belgian health care payer’s perspective (National Institute for Health and Disability Insurance [NIHDI]) associated with hospitalization due to FN in patients treated with chemotherapy for a solid tumor at the Antwerp University Hospital (UZA), Belgium, and to evaluate the use of the Multinational Association for Supportive Care in Cancer (MASCC) risk index score for identifying cancer patients with low-risk FN as screening tool at the emergency ward.

METHODS

Hospitalizations with diagnosis code FN between 01/01/2012 and 17/02/2018 were extracted from the UZA database. Eligible were patients >18y, with a solid tumor, treated with chemotherapy. FN was defined as ANC <500/mm³ with fever at home or at the emergency ward. Primary outcomes were direct costs, risk stratification, and length of stay (LOS). All FN related resources were included (hospitalization, antimicrobials, perfusions, lab tests, imaging tests, interventions, other drugs). Non-neutropenic related costs were not included. The MASCC risk index score was used to evaluate risk. Results were presented using descriptive statistics.

RESULTS

Included were 74 FN events occurring in 70 patients. Fifty-nine events (79.3%) were scored as low risk and 15 events (21.7%) as high risk. Four high risk events (26%) were fatal. The mean total cost per event for the entire population was €5,279.62 (2.5%-97.5% CI: €1,265 - €16,743). The mean cost was €4,891.88 (2,5%-97,5% CI: €1,946 - €12,289) and €6,804.70 (2,5%-97,5% CI: €923 - €19,924) for the low risk and high risk group, respectively. Mean and median LOS was 9 days (range 1-37) and 7 days, respectively.

CONCLUSIONS

FN is associated with considerable direct costs, mainly driven by the cost of hospitalization (90%). Eighty percent of our patients were at low risk according to MASCC and might have qualified for ambulatory treatment. The FN event led to modifications in the subsequent therapy in 61 % of patients.