INTRODUCTION Home-based treatment of low-risk febrile neutropenia (FN)
in children with cancer with oral or intravenous antibiotics is safe and
effective. There are limited data on the economic impact of this model
of care. We evaluated the cost-effectiveness of implementing a low-risk
FN program, incorporating home-based intravenous antibiotics, in a
tertiary pediatric hospital. METHODS A decision analytic model was
constructed to compare costs and outcomes of the low-risk FN program,
with usual in-hospital treatment with intravenous antibiotics. The
program included a clinical decision rule to identify patients at
low-risk for severe infection and home-based eligibility criteria using
disease, chemotherapy and patient-level factors. Health outcomes
(quality-of-life) and probabilities of FN risk classification and
home-based eligibility were based on prospectively collected data.
Patient-level costs were extracted from hospital records.
Cost-effectiveness was expressed as the incremental cost per
quality-adjusted life year (QALY). FINDINGS The mean healthcare cost of
home-based FN treatment in low-risk patients was A$7,765 per patient
compared to A$20,396 for in-hospital treatment (mean difference
A$12,632 (95% CI,12,496-12,767)). Overall, the low-risk FN program was
the dominant strategy, being more effective (0.0011 QALY (95%
CI,0.0011-0.0012)) and less costly. Results of the model were most
sensitive to proportion of children eligible for home-based care
program. CONCLUSION Compared to in-hospital FN care, the low-risk FN
program is cost-effective, with savings arising from cheaper cost of
caring for children at home. These savings could increase as more
patients eligible for home-based care are included in the program.
Oral ciprofloxacin in the management of children with cancer with lower risk febrile neutropenia
