Exploring Febrile Neutropenia in a Tertiary Care Hospital: Current Trends, Economic Implications, and Clinical Insights

Background: Febrile neutropenia (FN) to date remains a significant cause of morbidity, mortality, and increased healthcare costs among oncology patients. Existing data on its economic implications in low- and middle-income countries (LMICs) is limited. Objective: To assess the trends of FN admissions in the inpatient setting and their resultant economic burden in patients with solid organ malignancies within an LMIC setting. Methods: We conducted a retrospective study at the Aga Khan University Hospital, Karachi, Pakistan, from June 2023 to September 2024. One hundred adult patients with solid malignancies who were admitted with FN were included. Demographic, clinical, and economic data were collected and analyzed. Patients were stratified by risk using the Multinational Association for Supportive Care in Cancer (MASCC) score. The primary outcomes of our study included the length of stay (LOS), antibiotic duration, and cumulative hospitalization cost. Results: Of the 100 patients, 49% were considered low risk (MASCC ≥21). The mean patient age was 54 years. High-risk patients had a longer LOS (6.3 vs. 3.2 days) and a longer antibiotic therapy duration (8 vs. 5 days). Grade 4 neutropenia was found in 60%. The mean hospitalization cost was approximated at $1,200-$1,800 USD per admission (average $350/day), with intravenous antibiotics accounting for 20% and granulocyte colony-stimulating factor 3% of the total costs. Conclusion: Implementing FN risk-based protocols in LMICs can enable safe outpatient management of low-risk patients, reduce healthcare costs by lowering admissions, and lessen the financial burden on patients in out-of-pocket payment healthcare settings.