title: Clinical and Cost Comparison Evaluation of Inpatient Versus Outpatient Administration of EPOCH-Containing Regimens in Non-Hodgkin Lymphoma.
abstract: BACKGROUND
  Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in non-Hodgkin's lymphoma, however, the incidence of febrile neutropenia (FN) in patients receiving inpatient versus outpatient EPOCH has not been described. Additionally, no comparisons have been made regarding financial implications of EPOCH administration in either setting. This study's primary objective was to compare hospital admissions for FN in patients receiving inpatient or outpatient EPOCH.
  
  
  METHODS
  A single-center, institutional review board-approved review was conducted for adults receiving EPOCH beginning January 2010. Clinical and financial data were collected through chart review and the institution's financial department. Descriptive statistics were utilized for analysis.
  
  
  RESULTS
  A total of 25 patients received 86 cycles of an EPOCH-containing regimen (61 [70.9%] inpatient). Five (8.2%) inpatient cycles resulted in an admission for FN compared to 4 (16%) outpatient cycles. Prophylactic antifungal and antiviral agents were prescribed more often after inpatient cycles (>80%) compared to outpatient cycles (<50%). Overall, 27 (31.4%) of 86 cycles did not receive granulocyte colony-stimulating factor support. Outpatient EPOCH administration was associated with a cost savings of approximately US$141 116 for both chemotherapy costs and hospital day avoidance.
  
  
  CONCLUSIONS
  EPOCH-containing regimens can be safely administered in the outpatient setting, which may result in cost savings for healthcare institutions.
authors.affiliation: 1 Department of Pharmacy, The Arthur G. James Cancer Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Evans
authors.affiliation: 2 Department of Pharmacy, Georgia Regents Medical Center, Augusta, GA, USA.
authors.forename: Arpita S
authors.initials: AS
authors.lastname: Gandhi
authors.affiliation: 3 Department of Pharmacy, Georgia Regents Medical Center, University of Georgia College of Pharmacy, Augusta, GA, USA.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Clemmons
authors.affiliation: 4 Department of Pharmacy, Georgia Regents University Cancer Center, University of Georgia College of Pharmacy, Augusta, GA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: DeRemer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics*; D003365:Costs and Cost Analysis / Q000592:standards*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000191:economics; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011241:Prednisone / Q000008:administration & dosage / Q000191:economics; D011446:Prospective Studies; D012189:Retrospective Studies; D014750:Vincristine / Q000008:administration & dosage / Q000191:economics
chemical_list: D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: EPOCH; cost; infection; neutropenia; outpatient