ALBERT

Description: Abstract 239 Background: Febrile neutropenia (FN) is a serious complication of myelosuppressive chemotherapy that often requires hospitalization. Published burden-of-illness estimates for FN-related hospitalizations were either based on clinical practice more than a decade ago (Caggiano et al Cancer 2005, Kuderer et al Cancer 2006) or derived from small samples (Schilling et al Exp Ther Med 2011). Methods: A retrospective cohort study was conducted to provide updated estimates using 2007–2010 hospital discharge data from a database maintained by Premier and containing service records of over 400 geographically diverse hospitals. It is one of the largest hospital databases in the U.S. The study population included adult patients with 1 of 6 tumor types (breast, lung, colorectal, ovarian cancers; non-Hodgkin lymphoma [NHL]; and Hodgkin lymphoma), discharge diagnoses of neutropenia (ICD-9 code 288.0x) with fever or infection, and receipt of intravenous antibiotics. The average hospitalization cost, case fatality rate, and average length of stay (LOS) associated with each patient's first FN-related hospitalization (index hospitalization) were computed with associated 95% confidence intervals (CIs) for all tumor types combined and stratified by tumor type. Detailed costs and resource utilization components within index hospitalizations were also examined and tallied. Tumor-type-specific multivariate linear regressions (for costs and LOS) and logistic regressions (for mortality) were conducted to assess the effect of infection types and comorbidities on study outcomes, adjusting for other patient and hospital characteristics. FN-related 30-day readmission rates after index hospitalizations were also estimated. All cost measures reflected actual direct costs to hospitals and were adjusted to 2010 dollars. Results: Hospitalization with FN was identified in 16,273 cancer patients. The mean (SD) age was 63 (14) years; 49% were aged ≥65 years; and 60% were female. Hospitalization costs and clinical outcomes of index hospitalizations varied by tumor type and by discharge status (Table). For all tumor types combined, 19% of patients were treated in an intensive care unit (ICU) setting during index hospitalizations, with average LOS of 5.2 days spent in ICU. The estimated models identified certain infection types and comorbidities as potential risk factors for inpatient mortality and predictors of higher economic burden. Of note, breast cancer patients with diagnosed septicemia/bacteremia (N=656) had average costs that were $5,664 (95% CI: $4,233–$7,095) higher than those with other infections (N=2,623), average LOS that was 1.7 days (95% CI: 1.0–2.3) longer, and a higher case fatality rate (risk ratio [as approximated by odds ratio]: 4.12, 95% CI: 2.6–6.5), after adjusting for other observed potential confounders. Higher average costs were also observed in NHL patients with diagnosed renal disease (N=1,263) than in those without renal disease (N=4,174) (adjusted difference: $10,408, 95% CI: $8,391–$12,425). The FN-related 30-day readmission rate after index hospitalization was 5.9% for all tumor types combined. The rate was 9.9% for NHL and 8.6% for Hodgkin lymphoma, higher than that in patients with other tumor types (2.3%–4.1%). Conclusions: FN-related hospitalizations among cancer patients are expensive, resource-intensive, and associated with considerable mortality risk. Substantial differences in the clinical and economic burden of FN exist depending on tumor types, infection types, and comorbidities. Disclosures: Dulisse: Premier healthcare alliance: Employment. Li:Amgen Inc.: Employment, Equity Ownership. Gayle:Premier healthcare alliance: Employment. Barron:Amgen Inc.: Employment, Equity Ownership. Ernst:Premier healthcare alliance, which contracted with Amgen to conduct this study.: Employment. Rothman:Dr. Rothman is an employee of RTI Health Solutions, an independent non-profit research organization that does work for government agencies and pharmaceutical companies.: Employment. Legg:Amgen Inc.: Employment, Equity Ownership. Kaye:RTI Health Solutions (a business unit of RTI International): Employment.

Description: Abstract 4232 Background: Febrile neutropenia (FN) is a life-threatening side effect of myelosuppressive chemotherapy. The incidence and consequences of FN requiring inpatient care have been evaluated using healthcare claims or hospital administrative databases (Kuderer et al, Cancer 2006; Caggiano et al, Cancer 2005; Lyman et al, Eur J Cancer 1998). These sources did not include absolute neutrophil counts (ANC) and body temperature; thus the accuracy of case-ascertainment methods and findings is unknown. Moreover, none of these studies considered FN managed in the outpatient setting. Because some of these limitations may be overcome using electronic health records (EHR), a new study was undertaken. Methods: Data were obtained from Humedica's National EHR-Derived Longitudinal Patient-Level Database (2007–2010), which includes comprehensive point-of-care information from EHR and administrative data stores across the continuum of care for ∼5 million patients. The study population included adult patients who initiated 1 or more new courses of myelosuppressive chemotherapy for the treatment of a solid tumor or non-Hodgkin's lymphoma (NHL). For each patient, each chemotherapy course and each cycle within each course was identified. FN was identified on a cycle-specific basis based on ANC

Description: Abstract 2082 Background: Several studies have identified older age as one of the risk factors for severe neutropenia, febrile neutropenia (FN), and related outcomes including hospitalization following myelosuppressive chemotherapy. Older age is also associated with the increased likelihood of comorbid conditions, greater severity of illness, decline in performance status, and other risk factors for complications following chemotherapy. No study has yet described the effect of age while controlling for these age-related risk factors for febrile neutropenia following chemotherapy. This analysis describes the effect of age, adjusted for patient and treatment characteristics and measurable comorbidities, on the incidence of hospitalization for any reason and also on neutropenia-related hospitalization in non-Hodgkin's lymphoma (NHL) patients receiving chemotherapy. Methods: Using U.S. claims data from 01 January 2006 through 31 December 2009, we examined rates of all-cause hospitalization and neutropenia-related hospitalization for patients with NHL aged 18 to 89 years, during their first course of chemotherapy (when patients are at highest risk for neutropenia-related hospitalization). Neutropenia was identified in claims as ICD-9-CM code 288.0. We fitted a cubic spline regression curve based on the regression spline model that best predicted the association between hospitalization and age, adjusting for sex of the patient, treatment characteristics (type of chemotherapy, cycle length), chronic comorbidities (using the Deyo-Charlson comorbidity index), and use of filgrastim, pegfilgrastim, or sargramostim (G/GMCSF) as primary prophylaxis (defined as use within the first 5 days of the first cycle). Results are presented numerically and graphically with simultaneous 95% confidence intervals. Results: We identified 4,048 patients with NHL who were receiving chemotherapy. Approximately half (55%) were male; mean age was 61 years (standard deviation, 15 years) (table). The most common first cycle administration schedule was every 3 weeks (Q3W), reported for 64% of courses. Primary prophylaxis with G/GMCSF was administered in 49% of the chemotherapy courses. The risk of hospitalization for any cause was approximately 20% at age 20, rising in a nearly linear fashion to approximately 28% at age 80 (graph; R2 = 0.0421). The risk of neutropenia-related hospitalization was approximately 2% at age 20 and approximately 5% at age 80 (graph; R2 = 0.0125). Conclusions: After adjusting for sex, treatment characteristics, chronic comorbidities, and use of primary prophylaxis with G/GMCSF, older age is associated with a moderate, nearly linear increase in the risk of hospitalization from any cause and a more modest but similar increase in neutropenia-related hospitalization. Disclosures: Deeter: Amgen Inc.: Employment, Equity Ownership. Kaye:Amgen Inc.: Consultancy. Legg:Amgen Inc.: Employment, Equity Ownership. Rothman:RTI Health Solutions: Employment.