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Estimating resource use and cost of prophylactic management of neutropenia with filgrastim

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annemans l., van overbeke n., standaert b. & van belle s.(2005) Journal of Nursing Management13, 265–274

Estimating resource use and cost of prophylactic management of neutropenia with filgrastim

The study objective is to develop a methodology for the measurement of time, resource use and cost of the prophylactic management of neutropenia with filgrastim in different settings where the drug is routinely used: in-hospital care, outpatient care and home care. The activity-based costing method is used to analyse the cost of managing prophylactically neutropenia and comprises four steps. First, department heads in each of the chosen settings were selected and interviewed to obtain key elements in the workflow that involves the management of neutropenia, followed by the second step involving in-depth, structured interviews of key personnel. The third step was the measurement of the time required for frequently occurring activities in monitoring neutropenia and the administration of filgrastim by a study nurse. Finally, information on resource unit costs and personnel salaries were collected from the administration units to calculate an average cost. Sensitivity analyses were undertaken on estimated variables in the study. A list of eight to 14 consecutive activities linked to the prophylactic management of neutropenia was observed. The number and type of activities do not differ between an in-hospital oncology ward and an outpatient setting except for blood samplings. The difference is more pronounced between hospital and home care settings, as in the latter the patient performs many of the activities him/herself. The cost estimate per setting for prophylactic drug use is €6.30 for in-hospital care, €3.67 for outpatient care and €5.49 for home care. Taking the two most frequently occurring scenarios per chemotherapy cycle (i.e. with or without febrile neutropenia), the following cost estimates are obtained: €60.41 for a patient with febrile neutropenia and €56.77 for a patient without febrile neutropenia, excluding drug costs. With the activity-based costing method it is possible to accurately demonstrate cost savings in the management of neutropenia using the newer drug therapies.
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Keywords: cost; neutropenia; prophylactic use

Document Type: Research Article

Affiliations: 1: HEDM, Meise 2: Associate Director, AMGEN, Europe 3: UZ, Ghent, Belgium

Publication date: May 1, 2005

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