title: Economic comparison of home-care-based versus hospital-based treatment of chemotherapy-induced febrile neutropenia in children.
abstract: OBJECTIVE
  The purpose of this study was to compare health-care resource utilization and outcomes among children treated for low-risk febrile neutropenia (FN) in a hospital-based setting with those treated in a home-care-based setting.
  
  
  METHODS
  The perspective of this retrospective, cohort study was the health payer. We collected health-care utilization and treatment outcome data from medical records of 63 children (26 boys and 37 girls) with low-risk, chemotherapy-induced FN who were treated at the University of Arizona (27 children, the hospital-based group) and University of New Mexico (36 children, the home-care-based group). We identified 144 FN episodes (72 episodes in each group). Health-care utilization included physician visits, home-care visits, laboratory visits, outpatient visits, hospital days, intensive care unit days, medical tests and studies, and medications used to manage FN (e.g., filgrastim, antimicrobials, and ancilliary drugs and supplies). We applied uniform charges, based on those used at the University of New Mexico in 1998. We collected outcomes of the FN treatment (success vs. failure and time to resolution, defined as number of days of antibiotic therapy). Rates of positive blood cultures during treatment were also compared. Data were analyzed using nonparametric Mann-Whitney U tests for continuous data and chi-square analysis for categorical data. Sensitivity analyses were conducted by varying the amount of total resource utilization, as well as utilization of specific health-care resources.
  
  
  RESULTS
  There was no difference in outcome; all episodes of treatment in both groups resulted in successful recovery from FN. Time to resolution of FN was 8.3 +/- 2.7 days for home-care FN episodes versus 7.3 +/- 3.6 days for hospital FN episodes (P =.064). Median charge per FN episode was significantly (P<.001) greater when managed in the hospital compared to home care (9392 US dollars vs. 5893 US dollars). There was greater use of laboratory and radiographic studies in the hospital-based patients (P <.01). However, children in the home-care-based group were more often treated with granulocyte colony-stimulating factor (filgrastim, median charge 1085 US dollars vs. 451 US dollars, P <.001), and median antibiotic charges were higher (2523 US dollars vs. 1526 US dollars, P <.001). Positive blood cultures were more common among the hospital-based FN treatments (30.6 vs. 11.1%, P=.012).
  
  
  CONCLUSIONS
  We found that management of low-risk FN in a home-care-based setting was associated with significantly lower median total charges with no differences in outcome.
authors.affiliation: Veterans Affairs Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA. dwraisch@unm.edu
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Raisch
authors.forename: Mark T
authors.initials: MT
authors.lastname: Holdsworth
authors.forename: Stuart S
authors.initials: SS
authors.lastname: Winter
authors.forename: John J
authors.initials: JJ
authors.lastname: Hutter
authors.forename: Michael L
authors.initials: ML
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014600:Utilization Review
chemical_list: D000970:Antineoplastic Agents