PCN13: COST OF THROMBOCYTOPENIA-RELATED BLEEDING AMONG PATIENTS WITH CANCER

Abstract

OBJECTIVE: Chemotherapy-induced bone marrow toxicity is expensive because of the cost of managing complications of pancytopenia. Growth factors minimize these complications. Economic analyses of growth factors typically focus on common, less serious outcomes, rather than on rare, serious outcomes. As a result, the samples are too small to estimate the financial burden of less common outcomes; underestimation of the economic value of these agents may occur. To illustrate, we examined the cost of a less common, but serious outcome of chemotherapy, thrombocytopenia-related bleeding, in large and small samples of cancer patients. METHOD: The cost of 1562 chemotherapy cycles in 612, randomly-chosen cancer patients was estimated from retrospective review of medical and administrative databases. Cost was estimated using a resource-based strategy (pharmaceuticals, hospital and clinic costs, transfusions) from the provider's perspective, in 1999 dollars. Twelve random, 10% samples of the cycles were selected, approximating the size of most growth factor trials. Mean costs were compared with two-tailed t-tests. RESULTS: Using the entire sample, cycles with thrombocytopenia were more expensive than those without ($7933 vs 4875, p < 0.0001). Cycles with bleeding were more expensive than those without ($13,728 vs $7374, p < 0.0001). They were comparable in the costs of all inpatient and outpatient services except monitoring ($538 vs $472, p = 0.01), transfusions to prevent bleeding ($1367 vs $758, p = 0.007), and bleeding treatment ($4702 vs $0, p < 0.0001). However, the cost of cycles with bleeding (range: $8289?$16,277) was significantly higher than cycles without bleeding (range: $5796?$8872) in only 5 of the 12 small samples. CONCLUSIONS: The economic impact of uncommon, but expensive outcomes should be examined in samples large enough to permit calculation of stable estimates of cost. The high cost of rare outcomes such as bleeding will be better appreciated, as will the importance of avoiding such episodes by preventing thrombocytopenia.