| Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer. | |
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MedLine Citation:
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PMID: 21220399 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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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. |
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Authors:
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Oliver Teuffel; Eitan Amir; Shabbir M H Alibhai; Joseph Beyene; Lillian Sung |
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Publication Detail:
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Type: Journal Article Date: 2011-01-10 |
Journal Detail:
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Title: Pediatrics Volume: 127 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-02-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: e279-86 Citation Subset: AIM; IM |
Affiliation:
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Division of Haematology/Oncology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. lillian.sung@sickkids.ca. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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