title: Cost-effectiveness of outpatient management for febrile neutropenia in children with cancer.
abstract: OBJECTIVE
  Inpatient management remains the standard of care for treatment of febrile neutropenia (FN) in children with cancer. Clinical data suggest, however, that outpatient management might be a safe and efficacious alternative for patients with low-risk FN episodes.
  
  
  METHODS
  A cost-utility model was created to compare 4 treatment strategies for low-risk FN. The base case considered pediatric cancer patients with low-risk FN. The model used a health care payer's perspective and a time horizon of 1 FN episode. Four treatment strategies were evaluated: (1) entire treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge consisting of 48 hours of inpatient observation with intravenous antibiotics followed by oral outpatient treatment (EarlyDC); (3) entirely outpatient management with intravenous antibiotics (HomeIV); and (4) entirely outpatient management with oral antibiotics (HomePO). Outcome measures were quality-adjusted FN episodes (QAFNEs), costs (Canadian dollars), and incremental cost-effectiveness ratios. Parameter uncertainty was assessed with probabilistic sensitivity analyses.
  
  
  RESULTS
  The most cost-effective strategy was HomeIV. It was cost-saving ($2732 vs $2757) and more effective (0.66 vs 0.55 QAFNE) as compared with HomePO. EarlyDC was slightly more effective (0.68 QAFNE) but significantly more expensive ($5579) than HomeIV, which resulted in an unacceptably high incremental cost-effectiveness ratio of more than $130 000 per QAFNE. HospIV was the least cost-effective strategy because it was more expensive ($14 493) and less effective (0.65 QAFNE) than EarlyDC.
  
  
  CONCLUSIONS
  The findings of this decision-analytic model indicate that the substantially higher costs of inpatient management cannot be justified on the basis of safety and efficacy considerations or patient/parent preferences.
authors.affiliation: Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Oliver
authors.initials: O
authors.lastname: Teuffel
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000379:methods; D002648:Child; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019468:Disease Management; D005334:Fever / Q000191:economics* / Q000209:etiology / Q000628:therapy; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000191:economics* / Q000628:therapy; D009503:Neutropenia / Q000191:economics* / Q000209:etiology / Q000628:therapy