title: Effect of outpatient treatment of febrile neutropenia on the risk threshold for the use of CSF in patients with cancer treated with chemotherapy.
abstract: OBJECTIVE
  Febrile neutropenia (FN) in patients with cancer treated with chemotherapy has traditionally been managed with inpatient broad-spectrum antibiotics until the infection and neutropenia have resolved. A newer strategy is outpatient oral or intravenous antibiotics in selected patients after an initial hospitalization. We sought to determine these costs, both overall and relative to those of traditional management, and the optimal role of prophylactic colony-stimulating factor (CSF) in patients at greatest risk for FN.
  
  
  METHODS
  Existing economic decision models were modified by incorporating a treatment strategy for FN in which patients are classified as high- and low-risk according to criteria described by Talcott. Low-risk patients were assumed to be treated as outpatients. Overall costs with the revised economic model were assessed and sensitivity analyses were performed.
  
  
  RESULTS
  The costs of an episode of FN were estimated as 1) no CSF: dollar 13,355; 2) CSF with hospitalization for FN: dollar 8677; and 3) CSF with risk stratification and outpatient management in low-risk patients: dollar 8188. The risk threshold for the cost-effective use of CSF was only slightly lower with outpatient treatment. When all patients with FN are treated as inpatients and the cost of hospitalization is dollar 1750/day the risk threshold for FN at which prophylactic CSF becomes cost-effective is 16%. It is 15% when low-risk patients are treated as outpatients.
  
  
  CONCLUSIONS
  Outpatient treatment slightly decreases the risk threshold for FN at which prophylactic CSF becomes cost-effective. The limited economic effect of this strategy may be because the patients who were at greatest risk of complications had significantly longer lengths of stay and accounted for most of the hospitalization costs.
authors.affiliation: Albany College of Pharmacy,Albany, NY, USA.
authors.forename: Leon E
authors.initials: LE
authors.lastname: Cosler
authors.forename: Visaharan
authors.initials: V
authors.lastname: Sivasubramaniam
authors.forename: Olayemi
authors.initials: O
authors.lastname: Agboola
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Crawford
authors.forename: David
authors.initials: D
authors.lastname: Dale
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000592:standards; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003115:Colony-Stimulating Factors / Q000191:economics* / Q000627:therapeutic use; D003361:Cost Allocation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004180:Direct Service Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D017050:Episode of Care; D005334:Fever / Q000139:chemically induced / Q000145:classification / Q000191:economics / Q000517:prevention & control; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D017059:Models, Econometric; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000145:classification / Q000191:economics / Q000517:prevention & control*; D009518:New York; D018579:Patient Selection; D018570:Risk Assessment / Q000458:organization & administration*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors