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42
THE DEVELOPMENT OF A COMMUNITY ONCOLOGY COST MODEL FOR CHEMOTHERAPY-INDUCED
NEUTROPENIA. Michelle Peterson, MHA, RN, OCN®, Kathryn Wheetley, Barry
Fortner, PhD, Ted Okon, MBA, and Kelley Moore, RN, The West Clinic, Memphis,
TN.
Background: Chemotherapy-induced neutropenia (CIN) is a frequent problem
for cancer patients that has been shown to produce significant financial
burden. However, previous research has focused primarily on the medical
treatment costs of febrile neutropenia (FN) defined in relation to patients,
hospitals, and third-party payers. Less is known about costs incurred
and staff resources utilized, especially by community oncology nurses
in the continuous care of the full range of CIN, including patient education,
monitoring of blood counts, and treating CIN. This paper describes a resource
cost model currently being used in a national economic impact study of
CIN in community oncology clinics.
Methods: The model is based on 21-day chemotherapy regimens. Two neutropenia-treatment
scenarios are the focus of the model: chemotherapy with prophylactic granulocyte
colony-stimulating factor (G-CSF) and chemotherapy without prophylactic
G-CSF. Data were collected in four specific areas: Patient medical encounters
(chemotherapy administration, nadir check, G-CSF treatment, etc.); practice
medical events (phlebotomy, nurse triage, billing, etc.); medical tasks
(specific, discrete behaviors of medical staff that constitute medical
events such as patient teaching, hanging an IV antibiotic, marking the
fee ticket, etc); and practice costs defined by dollar figures corresponding
to the time expended by paid employees including physicians, nurses, technicians,
and all supporting staff in performing medical tasks.
Results: A flexible outpatient-based cost model was developed. One hundred
ninety-six (196) medical tasks (approximately 40% performed by nurses),
21 medical events, and 15 medical encounters were defined to form the
basis of the model. The model is described in detail and graphical representations
of treatment scenarios, medical encounters, medical events, and medial
tasks are presented.
Discussion: The treatment of neutropenia in community oncology is a complex
phenomenon that involves many professional people and activities resulting
in substantial human resource cost. The model developed will serve as
a useful tool in developing a national picture of these costs in community
oncology. The identification of these costs may further understanding
of practice dynamics operating in the care of CIN and will provide needed
information to evaluate the cost effectiveness of G-CSF in the community
oncology setting.
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