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- Title
Cost effectiveness of outpatient treatment for febrile neutropaenia in adult cancer patients.
- Authors
Teuffel, O; Amir, E; Alibhai, S; Beyene, J; Sung, L
- Abstract
<bold>Background: </bold>There is uncertainty whether low-risk episodes of febrile neutropaenia (FN) in adult cancer patients are best managed in the in- or outpatient setting.<bold>Methods: </bold>A Monte Carlo cost-utility model was created to compare four treatment strategies for low-risk FN: (1) treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge after 48 h in-patient observation, followed by oral outpatient treatment (EarlyDC); (3) outpatient management with IV antibiotics (HomeIV); and (4) outpatient management with oral antibiotics (HomePO). The model used a health-care payer perspective and a time horizon of one FN episode. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollars) and incremental cost-effectiveness ratios (ICER). Parameter uncertainty was assessed with probabilistic sensitivity analyses.<bold>Results: </bold>HomePO was cost saving ($3470 vs $4183), but less effective (0.65 QAFNE vs 0.72 QAFNE) than HomeIV. The corresponding ICER was $10,186 per QAFNE. Both EarlyDC ($6115; 0.66 QAFNE) and HospIV ($13,557; 0.62 QAFNE) were dominated strategies. At a willingness-to-pay (WTP) threshold of $4,000 per QAFNE, HomePO and HomeIV were cost effective in 54 and 38% of simulations, respectively.<bold>Interpretation: </bold>For adult cancer patients with an episode of low-risk FN, treatment in hospital is more expensive and less effective than outpatient strategies.
- Subjects
FEBRILE neutropenia; CANCER patients; COST effectiveness; OUTPATIENT medical care; DIRECT costing; HOSPITAL care; THERAPEUTICS; TREATMENT of fever; INTRAVENOUS therapy; ANTIBIOTICS; ANTINEOPLASTIC agents; COMPARATIVE studies; DECISION trees; FEVER; HOSPITAL costs; RESEARCH methodology; MEDICAL cooperation; NEUTROPENIA; ORAL drug administration; RESEARCH; RESEARCH funding; SYSTEM analysis; TIME; TUMORS; EVALUATION research; DISCHARGE planning; STATISTICAL models; DISEASE complications; ECONOMICS
- Publication
British Journal of Cancer, 2011, Vol 104, Issue 9, p1377
- ISSN
0007-0920
- Publication type
journal article
- DOI
10.1038/bjc.2011.101