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American Academy of Pediatrics
Article

Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer

Oliver Teuffel, Eitan Amir, Shabbir M. H. Alibhai, Joseph Beyene and Lillian Sung
Pediatrics February 2011, 127 (2) e279-e286; DOI: https://doi.org/10.1542/peds.2010-0734
Oliver Teuffel
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Eitan Amir
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Shabbir M. H. Alibhai
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Joseph Beyene
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Lillian Sung
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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.

CONCLUSION: 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.

  • cost-effectiveness
  • fever
  • neutropenia
  • outpatient
  • ambulatory care
  • Accepted October 28, 2010.
  • Copyright © 2011 by the American Academy of Pediatrics

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Pediatrics
Vol. 127, Issue 2
1 Feb 2011
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Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer
Oliver Teuffel, Eitan Amir, Shabbir M. H. Alibhai, Joseph Beyene, Lillian Sung
Pediatrics Feb 2011, 127 (2) e279-e286; DOI: 10.1542/peds.2010-0734

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Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer
Oliver Teuffel, Eitan Amir, Shabbir M. H. Alibhai, Joseph Beyene, Lillian Sung
Pediatrics Feb 2011, 127 (2) e279-e286; DOI: 10.1542/peds.2010-0734
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Cited By...

  • Quest for certainty regarding early discharge in paediatric low-risk febrile neutropenia: a multicentre qualitative focus group discussion study involving patients, parents and healthcare professionals in the UK
  • Economic Evaluation of Pediatric Cancer Treatment: A Systematic Literature Review
  • Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation
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