Economic evaluation of antineoplasic chemotherapy administered at home or in hospitals.
OBJECTIVE
Comparative economic evaluations of chemotherapy administered in hospital day-care units or in the home are relatively scarce. Furthermore, most existing evaluations do not include methodologic studies. This study seeks to compare the costs of anticancer chemotherapy with hospital at-home care versus a hospital day-care unit in the Rhône-Alpes region of France.


METHODS
This study is based on a randomized controlled crossover trial that included 42 patients, to whom chemotherapy courses were alternatively given in both settings. All cost categories were taken into account according to microcosting methods. A detailed assessment was performed on coordination and health care in both structures (marginal costs and average costs), from the viewpoint of society.


RESULTS
The marginal cost for one chemotherapy administration was significantly higher with hospital at-home care than in the hospital day-care unit ($232.5 vs. $157, p < .0001). Conversely, the average cost was significantly lower with home care than at the hospital ($252.6 vs. $277.3, p = .0002).


CONCLUSIONS
The results show that the interest of developing home care in anticancer chemotherapy is questionable regarding costs. In the French healthcare system, where there is a surplus of hospital beds, marginal costs seem to be more relevant indicators in most cases than average costs.
Remonnay
Raphaël
R
Lyon-1 University.
Devaux
Yves
Y
Chauvin
Franck
F
Dubost
Eric
E
Carrère
Marie Odile
MO
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics; D017281:Cost of Illness; D018592:Cross-Over Studies; D003631:Day Care, Medical / Q000191:economics* / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D005602:France; D017048:Health Care Costs / Q000706:statistics & numerical data*; D018575:Home Care Services, Hospital-Based / Q000191:economics* / Q000706:statistics & numerical data; D018718:Home Infusion Therapy / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics*; D010045:Outpatients / Q000523:psychology; D017060:Patient Satisfaction / Q000191:economics* / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires
D000970:Antineoplastic Agents