title: Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial.
abstract: OBJECTIVE
  For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation.
  
  
  METHODS
  We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008.
  
  
  RESULTS
  Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work.
  
  
  CONCLUSIONS
  Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.
authors.affiliation: Health Care Financing & Economics, Veterans Administration Boston Healthcare System, Boston, MA 02130, USA. ann.hendricks@va.gov
authors.forename: Ann M
authors.initials: AM
authors.lastname: Hendricks
authors.forename: Elizabeth Trice
authors.initials: ET
authors.lastname: Loggers
authors.forename: James A
authors.initials: JA
authors.lastname: Talcott
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D005260:Female; D005334:Fever / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications; D009503:Neutropenia / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents