title: Cost effectiveness of outpatient treatment for febrile neutropaenia in adult cancer patients.
abstract: BACKGROUND
  There is uncertainty whether low-risk episodes of febrile neutropaenia (FN) in adult cancer patients are best managed in the in- or outpatient setting.
  
  
  METHODS
  A Monte Carlo cost-utility model was created to compare four treatment strategies for low-risk FN: (1) treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge after 48 h in-patient observation, followed by oral outpatient treatment (EarlyDC); (3) outpatient management with IV antibiotics (HomeIV); and (4) outpatient management with oral antibiotics (HomePO). The model used a health-care payer perspective and a time horizon of one FN episode. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollars) and incremental cost-effectiveness ratios (ICER). Parameter uncertainty was assessed with probabilistic sensitivity analyses.
  
  
  RESULTS
  HomePO was cost saving ($3470 vs $4183), but less effective (0.65 QAFNE vs 0.72 QAFNE) than HomeIV. The corresponding ICER was $10,186 per QAFNE. Both EarlyDC ($6115; 0.66 QAFNE) and HospIV ($13,557; 0.62 QAFNE) were dominated strategies. At a willingness-to-pay (WTP) threshold of $4,000 per QAFNE, HomePO and HomeIV were cost effective in 54 and 38% of simulations, respectively.
  
  
  CONCLUSIONS
  For adult cancer patients with an episode of low-risk FN, treatment in hospital is more expensive and less effective than outpatient strategies.
authors.affiliation: Division of Haematology/Oncology, Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M6G 1X8.
authors.forename: O
authors.initials: O
authors.lastname: Teuffel
authors.forename: E
authors.initials: E
authors.lastname: Amir
authors.forename: S
authors.initials: S
authors.lastname: Alibhai
authors.forename: J
authors.initials: J
authors.lastname: Beyene
authors.forename: L
authors.initials: L
authors.lastname: Sung
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics* / Q000379:methods; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D005334:Fever / Q000191:economics / Q000209:etiology / Q000628:therapy; D017721:Hospital Costs; D006801:Humans; D007262:Infusions, Intravenous / Q000191:economics; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D010351:Patient Discharge; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents