Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia.
OBJECTIVE
We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN).


METHODS
A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests.


RESULTS
Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001).


CONCLUSIONS
Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.
Elting
Linda S
LS
Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd (Unit 447), Houston, TX 77030, USA. lelting@mdanderson.org
Lu
Charles
C
Escalante
Carmelita P
CP
Giordano
Sharon H
SH
Trent
Jonathan C
JC
Cooksley
Catherine
C
Avritscher
Elenir B C
EB
Shih
Ya-Chen Tina
YC
Ensor
Joe
J
Bekele
B Nebiyou
BN
Gralla
Richard J
RJ
Talcott
James A
JA
Rolston
Kenneth
K
D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D015331:Cohort Studies; D019091:Critical Pathways; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D013781:Texas; D016896:Treatment Outcome