Single Institution Studies

Total hospitalization costs associated with admission with FN to the H. Lee Moffitt Cancer Center and Research Institute over a 2-yr period have been reported (16). Data were retrieved on patient demographics, diagnostic and procedure coding, outpatient and inpatient costs, and payor reimbursement. A cost allocation function was used to allocate all fixed and variable direct costs for nonrevenue-generating centers to the revenue-generating centers as indirect costs. In the allocation process, each support center was assigned an allocation statistic based on an appropriate measure of activity such as utilized space, supplies, and work-hours of activity. Each service center was assigned a portion of the overhead center's cost based on its share of the allocation statistic. The total operating expenses for each department represented the sum of direct and indirect institutional costs across all diagnostic and procedure codes assigned to the department. During fiscal years 1994 and 1995, 794 patients were admitted with FN. The primary reasons for admission consisted of neutropenia (39%), malignancy-related conditions (34%), infection-related conditions (11%), vascular complications (4%), and other organ system complications (12%). Approximately one-half of the patients were between 40 and 65 yr of age, and 25% were 65 yr of age or over in both groups. As shown in Fig. 8, patients with FN as the first (primary) diagnosis had relatively short LOS, whereas >25% of patients experienced an LOS of >3 wk overall. Patients with solid tumors spent a total of 3279 d in the hospital during the period under study, with an average LOS of 10.4 d. Total operating expenses including both direct and

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Length of Stay (Days)

Fig. 9. Frequency distribution of the length of stay in days among adults excluding bone marrow transplantation patients hospitalized for FN in institutions reporting to the University Health System Consortium, 1995-2000 (59).

indirect costs were greatest for the nursing unit (38%), followed by the pharmacy (27%), the blood bank (17%), and the laboratory (6%).

More recently, economic studies of FN in the multiple institutions reporting discharge data to the University Health System Consortium including 115 academic medical centers have been reported (59). In all, 55,276 episodes of FN in 41,779 adult nontransplant patients were reported over a 6-yr period. The average age of the patients was 53.6 yr; 73% were white, 54% were women, and 53% had a solid tumor, whereas 26% had lymphoma and 21% had leukemia. Cost data were available for 52,384 (95%) of the episodes. As shown in Fig. 9, the distributions of LOS, and therefore cost, are skewed to the right, related to a relatively small proportion of patients with more complicated and prolonged hospitalizations. The approx 30% of patients hospitalized for >10 d account for 74% of the hospital days and 78% of the cost. Hospitalization for FN over the 6-yr period totaled 619,837 hospital days and a total cost of approximately US $1 billion.

As shown in Table 1, the LOS and costs are remarkably similar to those reported in studies from clinical trials and the single institutional data discussed above. The average LOS decreased over the 6-yr period by 10%, whereas the cost per day increased by 28%, raising the total cost per episode of FN by 13% (Fig. 10). Significant predictors of long LOS and high cost were admissions associated with other medical conditions, a diagnosis of leukemia, and complications during hospitalization. The mean LOS was

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