title: A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment.
abstract: BACKGROUND
  Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration.
  
  
  METHODS
  A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria's hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care.
  
  
  RESULTS
  The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of 'low-risk' febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7-55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7-39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach.
  
  
  CONCLUSIONS
  This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing 'low-risk' febrile neutropenic patients.
authors: Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia. senthil.lingaratnam@petermac.org
authors: Senthil
authors: S
authors: Lingaratnam
authors: Leon J
authors: LJ
authors: Worth
authors: Monica A
authors: MA
authors: Slavin
authors: Craig A
authors: CA
authors: Bennett
authors: Suzanne W
authors: SW
authors: Kirsa
authors: John F
authors: JF
authors: Seymour
authors: Andrew
authors: A
authors: Dalton
authors: Bogda
authors: B
authors: Koczwara
authors: H Miles
authors: HM
authors: Prince
authors: Mary
authors: M
authors: O'Reilly
authors: Linda
authors: L
authors: Mileshkin
authors: Jeff
authors: J
authors: Szer
authors: Karin A
authors: KA
authors: Thursky
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics*; D003365:Costs and Cost Analysis / Q000379:methods; D005334:Fever / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D009503:Neutropenia / Q000188:drug therapy* / Q000191:economics*; D014739:Victoria