Cost-effectiveness of treating Febrile neutropenia in Children with Cancer in Resource-limited settings

Background: Febrile neutropenia in children on intensive chemotherapy is very frequent requiring urgent evaluation and management, imposing a significant strain on the already available limited resources in low-middle-income countries (LMIC) Objectives: To evaluate the need of cost-effectiveness in managing in-hospital FN and explore the mechanisms to implement in public sector LMIC to pave the way for cost-minimization Methodology: Prospective extraction of patient level costs from hospital records to evaluate the costing of injectable antimicrobial and inotropes provided by the hospital management free of cost as part of the comprehensive childhood cancer care Results: A total of 250 FN episodes were analyzed, all of them managed in the inpatient unit, complete cost data were extracted for these FN episodes. The analysis revealed that despite subsidized purchase of antimicrobials and supportive care materials FN has a huge burden on the public sector hospital resources whereas length of hospital stays, blood products, laboratory tests and staff consultations were excluded. Majority of these patients were of acute leukemia, having the last session of chemotherapy in a week time in 87% and majority on intensive chemotherapy and suffered from respiratory tract infections and mucositis. More than half had severe derangements of Laboratory parameters and gram-negative septicemia among positive cultures. The mean estimated cost per FN episode was around 15,000 PKR. Conclusion: Febrile neutropenia exerts a huge burden on childhood cancer care services emphasizing the need to explore the cost-effectiveness in FN management by different mechanisms including parents’ health literacy to promote early seeking behavior, emergency management, shared care therapy and social support and standardized de-escalation of therapy to minimize the costs.