The Epidemiology and Economics of Neutropenia in Hospitalized Adult Cancer Patients: Data From the University HealthSystem Consortium

Reviewer: Walter F. Sall, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 9, 2001

Presenter: Gary H. Lyman
Presenter's Affiliation: Albany Medical College
Type of Session: Poster


  • Neutropenia is a common toxicity of conventional chemotherapy accounting for a large percentage of inpatient hospital expenditures, particularly when neutropenia related fever results. Febrile neutropenia patients generally require hospitalization and broad spectrum antibiotics.
  • Efforts to reduce healthcare expenditures could benefit from an analsis of the component costs of febrile neutropenia hospitalizations. To date, these have been subject to limited study.
  • In this study, a large, nationwide discharge database is analyzed to study these component costs.

    Materials and Methods

  • The discharge dtatbase of the University HealthSystem Consortium, including 106 member institutions, was analyzed for febrile neutropenia admissions between 1995 and 2000. The patients were selected based on ICD-9 codes for both agranulocytosis and malignany.
  • Primary outcome measures included: length of stay (LOS), total cost per febrile neutropenia episode, cost per hospital day and inpatient mortality.
  • patients were stratified by tumor type, demographic factors and classification of febrile neutropenia as primary or secondary reason for hospitalization.


  • 62,703 episodes of febrile neutropenia in patients 18 or older were found. Mean patient age was 52.
  • Mean length of stay was 13 days. Mean total cost per episode was $24,802.
  • LOS and total cost per hospitalization were greatest for those with hematologic malignancies, being nearly double the corresponding figures for solid tumors.
  • LOS and total cost per hospitalization were greater in patients with secondary vs. primary febrile neutropenia reflecting the effect of additional co-morbidities in the secondary neutopenia group.
  • Over the 6 year period of the study, LOS decreased 7.5% while total cost per episode increased by 18.9%.

    Author's Conclusions

  • LOS and total cost per hospitalization were greatest for hematologic malignancies and in patients with additional complications and lowest in patients with primary febrile neutropenia.
  • Mortality in febrile neutropenia was associated with presence of co-morbidities, complications and age.
  • Though LOS has decresed over the past 6 years, cost per hospitalization continues to increase.
  • Baseline demographics and co-morbidities influence clinical and economic outcomes. Clinical prediction models are needed to identify those at highest risk of febrile neutropenia so appropriate prophylaxis can be administered.

    Clinical/Scientific Implications
    The rising costs of medical care can potentially be controlled by analyzing component costs of medical treatment allowing identification of high risk patients who may require prophylactic treatments to avoid extended hospitalizations. In this study, this technique is applied to febrile neutropenia patients, identifying hematologic malignancy patients and those with co-morbidities as being at increased risk of extended hospital stays for febrile neutropenia.

    Oncolink's ASH Coverage made possible by an unrestricted Educational Grant from Amgen.