Ambulatory high-dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost-effective.
BACKGROUND
We describe the safety, feasibility, and provide a cost-estimate of outpatient high-dose methotrexate administration (HDMTX) among an urban, underserved population.


METHODS
A retrospective analysis of ambulatory HDMTX administration among osteosarcoma patients, at Montefiore Medical Center's Children's Hospital (Bronx, NY) was performed. HDMTX (12 g/m(2)) was given intravenously (IV) over 4 hr after urine alkalinization. Patients were discharged home to continue IV hydration and alkalinization delivered via a home infusion pump. Families were instructed to monitor urine pH overnight and management was adjusted according to our institution's treatment algorithm until MTX level ≤ 0.1 µmol/L. A cost estimate was performed to assess the difference in costs for outpatient versus hypothetical inpatient administrations.


RESULTS
Of the 97 ambulatory HDMTX administrations, 99% were successfully completed. One patient failed outpatient administration secondary to home infusion pump malfunction. This patient successfully completed subsequent courses as an outpatient. Most patients (72%) had a MTX level of < 10 µmol/L at 24 hr post-HDMTX. No patients were found to have a MTX level of > 50 µmol/L at 24 hr. About 26% of courses were associated with grade III or IV neutropenia, 4% were associated with grade III or IV thrombocytopenia and 1% were associated with grade III/IV leukopenia. Compared to a hypothetical hospital inpatient stay, the hospital costs for ambulatory HDMTX were an average of $1400 less per cycle.


CONCLUSIONS
Ambulatory HDMTX administration among an underserved, urban population is safe, feasible, and cost-effective.
Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx, New York 10467, USA. krismd03@hotmail.com
Kris M
KM
Mahadeo
Ruth
R
Santizo
Lindsay
L
Baker
Joan O'Hanlon
JO
Curry
Richard
R
Gorlick
Adam S
AS
Levy
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D001859:Bone Neoplasms / Q000188:drug therapy*; D002648:Child; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D018718:Home Infusion Therapy / Q000191:economics; D017722:Hospital Charges; D006801:Humans; D007262:Infusions, Intravenous; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008507:Medically Underserved Area; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D012516:Osteosarcoma / Q000188:drug therapy*; D014505:Urban Population; D055815:Young Adult
D000964:Antimetabolites, Antineoplastic; D002955:Leucovorin; D008727:Methotrexate