Costos del manejo de la neutropenia febril en pacientes oncológicos en un hospital de tercer nivel en Colombia
DOI:
https://doi.org/10.35509/01239015.808Keywords:
neutropenia febril, neoplasias, análisis de costos, ColombiaAbstract
Purpose: To describe the clinical characteristics, resource utilization, and direct cost of febrile neutropenia (FN) in a healthcare institution in Colombia for patients seen between 2017-2019. Methods: A descriptive and retrospective study of a cohort of patients hospitalized due to FN. Costs were extracted from the review of medical records from diagnosis of FN until discharge or death, and official sources were used to estimate the cost. Results: Forty-four FN episodes were included. Median age was 61 years (IQR: 53-72). Solid tumors accounted for 68.8%. In first-line treatment were 14 (31.8%), same in proportion in adjuvant/neoadjuvant, and 5 (11.4%) in second-line. FN occurred in 15 (34.0%) high-risk patients. Mean LOS per episode was 5.1 ± 2.5 days. All patients were discharged alive. The median overall cost was $908 ± $769 per episode, with hospital stay being the main driver-cost. Conclusion: FN occurred mainly in advanced-stage solid tumors and in low-risk group. Higher costs in this cohort were found in long length of stay and high-risk patients.
References
Lynn J-J, Chen K-F, Weng Y-M, Chiu T-F. Risk factors associated with complications in patients with chemotherapy-induced febrile neutropenia in emergency department. Hematol Oncol. 2013 Dec;31(4):189–96. https://doi.org/10.1002/hon.2040.
Lustberg MB. Management of neutropenia in cancer patients. Clin Adv Hematol Oncol [Internet]. 2012 Dec;10(12):825–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23271355.
Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 2006 May 15;106(10):2258–66. https://doi.org/10.1002/cncr.21847.
Lyman GH, Lyman CH, Agboola O. Risk models for predicting chemotherapy-induced neutropenia. Oncologist [Internet]. 2005;10(6):427–37. https://doi.org/10.1634/theoncologist.10-6-427.
Madrid C, Díaz L, Combariza J, Gálvez K, Olaya V, Ramírez I, et al. Epidemiología de la neutropenia febril en pacientes adultos con neoplasia hematológica, en un período de 26 meses en el Hospital Pablo Tobón Uribe, Colombia. Rev Chil infectología [Internet]. 2013 Apr;30(2):195–201. http://dx.doi.org/10.4067/S0716-10182013000200010.
Rikimaru T, Ichiki M, Ookubo Y, Matumoto K, Mimori Y, Sueyasu Y, et al. Prognostic significance of febrile episodes in lung cancer patients receiving chemotherapy. Support Care Cancer [Internet]. 1998 Jul;6(4):396–401. https://doi.org/10.1007/s005200050183.
Link BK, Budd GT, Scott S, Dickman E, Paul D, Lawless G, et al. Delivering adjuvant chemotherapy to women with earlystage breast carcinoma: current patterns of care. Cancer [Internet]. 2001 Sep 15;92(6):1354–67. https://doi.org/10.1002/1097-0142(20010915)92:6%3C1354::aid-cncr1458%3E3.0.co;2-p.
Scott S. Identification of cancer patients at high risk of febrile neutropenia. Am J Health Syst Pharm [Internet]. 2002 Aug 1;59(15 Suppl 4):S16-9. https://doi.org/10.1093/ajhp/59.suppl_4.s16.
Lyman GH, Kuderer NM. Epidemiology of febrile neutropenia. Support Cancer Ther [Internet]. 2003 Oct 1;1(1):23–35. https://doi.org/10.3816/sct.2003.n.002.
Segal BH, Freifeld AG, Baden LR, Brown AE, Casper C, Dubberke E, et al. Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw. 2008 Feb;6(2):122-74. https://doi.org/10.6004/jnccn.2008.0013.
Schwenkglenks M, Jackisch C, Constenla M, Kerger JN, Paridaens R, Auerbach L, et al. Neutropenic event risk and impaired chemotherapy delivery in six European audits of breast cancer treatment. Support Care Cancer [Internet]. 2006 Sep;14(9):901–9. https://doi.org/10.1007/s00520-006-0034-9.
Tai E, Guy GP, Dunbar A, Richardson LC. Cost of Cancer-Related Neutropenia or Fever Hospitalizations, United States, 2012. J Oncol Pract. 2017 Jun;13(6):e552–61. https://doi.org/10.1200/jop.2016.019588.
McCullagh L, O´Brien C, Fogarty E, Walsh C, Dempsey O, Barry M, et al. A micro-costing of the inpatient management of febrile neutropenia in the irish health care setting. Value Heal. 2013; 16 (7) PA404. https://doi.org/10.1016/j.jval.2013.08.466.
Lyman GH, Kuderer N, Greene J, Balducci L. The economics of febrile neutropenia: implications for the use of colony-stimulating factors. Eur J Cancer [Internet]. 1998 Nov;34(12):1857–64. https://doi.org/10.1016/s0959-8049(98)00222-6.
Salazar L, Benavides M, Murcia EM. Actuar político para el control del cáncer en Colombia. Rev Gerenc y Políticas Salud. 2018;17(35). https://doi.org/10.11144/Javeriana.rgps17-35.apcc.
Wiesner C. La atención del cáncer desde la perspectiva de la sostenibilidad financiera del Sistema General de Seguridad Social en Colombia, Rev Colomb Cancerol. 2016; 20 (2) 49-51. https://doi.org/10.1016/j.rccan.2016.05.001.
Rojas L, Rojas-Reyes M, Rosselli D, Cardona A. Cost-Effectiveness Analysis of Genomic Profiling in Early Breast Cancer in Colombia, 24 August 2021, PREPRINT (Version 2) available at Research Square. https://doi.org/10.21203/rs.3.rs-264520/v2.
Instituto Nacional de Cancerología. Guía de práctica clínica para el diagnóstico y tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo. Bogotá D.C. Colombia: Instituto Nacional de Cancerología; 2013.
Banco de la República de Colombia. Tasa Representativa del Mercado (TRM - Peso por dólar). 2019.
Consejo Nacional de Seguridad Social en Salud. Manual Tarifario SOAT. 2021.
Ministerio de Salud y Protección Social de Colombia. Sistema de información de precios de medicamentos -SISMED. 2017.
Wang XJ, Lopez SE, Chan A. Economic burden of chemotherapy-induced febrile neutropenia in patients with lymphoma: A systematic review. Vol. 94, Critical Reviews in Oncology/Hematology. Elsevier Ireland Ltd; 2015. p. 201–12. https://doi.org/10.1016/j.critrevonc.2014.12.011.
Lathia N, Isogai PK, De Angelis C, Smith TJ, Cheung M, Mittmann N, Hoch JS, Walker S. Cost-effectiveness of filgrastim and pegfilgrastim as primary prophylaxis against febrile neutropenia in lymphoma patients. J Natl Cancer Inst. 2013 Aug 7;105(15):1078-85. https://doi.org/10.1093/jnci/djt182.
Whyte S, Cooper KL, Stevenson MD, Madan J, Akehurst R. Cost-effectiveness of granulocyte colony-stimulating factor prophylaxis for febrile neutropenia in breast cancer in the United Kingdom. Value Health. 2011 Jun;14(4):465-74. https://doi.org/10.1016/j.jval.2010.10.037.
Lyman GH, Lalla A, Barron RL, Dubois RW. Cost-effectiveness of pegfilgrastim versus filgrastim primary prophylaxis in women with early-stage breast cancer receiving chemotherapy in the united states. Clin Ther. 2009 May;31(5):1092–104. https://doi.org/10.1016/j.clinthera.2009.05.003.
Peña TA, Rojas JDP, Benavidez REB, Gómez TMS, Cadavid DCR, Ávila DA, et al. Características de los pacientes adultos con neutropenia febril en un hospital universitario (Medellín, 2012-2016). Med UPB [Internet]. 2019 Dec 15 [cited 2021 Nov 4];38(2):108–13. https://doi.org/10.18566/medupb.v38n2.a02.
Cataño-Toro D, Marín-Medina DS, Rivera J, Martínez JW, Sánchez-Duque JA, Martínez-Muñoz M, et al. Neutropenia febril asociada a quimioterapia en pacientes con neoplasias hematológicas de un centro de referencia en Colombia: características clínicas y desenlaces. Rev Salud Uninorte [Internet]. 2019 [cited 2021 Nov 4];35(2):205–20. https://doi.org/10.14482/sun.35.2.616.15.
Dulisse B, Li X, Gayle JA, Barron RL, Ernst FR, Rothman KJ, et al. A retrospective study of the clinical and economic burden during hospitalizations among cancer patients with febrile neutropenia. J Med Econ. 2013 Jun 12;16(6):720–35. https://doi.org/10.3111/13696998.2013.782034.
Zhou YP, Jin J, Ding Y, Chee YL, Koh LP, Chng WJ, et al. Direct costs associated with febrile neutropenia in inpatients with hematological diseases in Singapore. Support Care Cancer. 2014 Jun 28;22(6):1447–51. https://doi.org/10.1007/s00520-013-2055-5.
Aguado JM, Cruz JJ, Virizuela JA, Aguilar M, Carmona A, Cassinello J, et al. Management of Infection and Febrile Neutropenia in Patients with Solid Cancer. Enferm Infecc Microbiol Clin. 2017;35(7):451–60. https://doi.org/10.1016/j.eimc.2015.06.005.
Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropaenia: ESMO clinical practice guidelines. Ann Oncol. 2016;27:v111–8. 32. https://doi.org/10.1093/annonc/mdw325.
León E, Gamboa Ó, lo Lozano T, Gamboa C, Gil M, Fuentes J. Estudio de costo de la enfermedad en pacientes con cáncer de colon y recto en Colombia. Rev Colomb Cancerol. 2013 Dec;17(4):184. https://doi.org/10.1016/S0123-9015(13)70209-9.
Gamboa Ó, Buitrago LA, Lozano T, Dieleman S, Gamboa C, Guzmán ÉL, et al. Costos directos de la atención del cáncer de mama en Colombia. Rev Colomb Cancerol. 2016 Apr;20(2):52–60. http://dx.doi.org/10.1016/j.rccan.2016.02.003.
Cuenta de Alto Costo (CAC). Situación del cáncer en la población adulta atendida en el SGSSS de Colombia 2019. 2020.
Cuenta de Alto Costo (CAC). Situación del cáncer en la población adulta atendida en el SGSSS de Colombia 2020. 2021.
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