A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment

Lingaratnam, Senthil; Worth, Leon J; Slavin, Monica A; Bennett, Craig A.; Kirsa, Suzanne W; Seymour, John F.; Dalton, Andrew; Koczwara, Bogda; Prince, H. Miles; O’Reilly, Mary; Mileshkin, Linda; Szer, Jeffrey; Thursky, Karin

doi:10.1071/ah10951

Cited by 18 publications

(21 citation statements)

References 27 publications

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“…An Australian cost analysis showed a 30% saving for ambulatory care strategies when compared with standard hospital care [49]. Considering the high economic cost for the health care system of hospitalized BC patients with FN, managing as many patients as possible in an outpatient setting should be a key task in modern medical oncology.…”

Section: Discussionmentioning

confidence: 99%

Management of Breast Cancer Patients with Chemotherapy-Induced Neutropenia or Febrile Neutropenia

et al. 2014

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Chemotherapy-induced neutropenia (CIN) is a common toxicity caused by the administration of anticancer drugs. This side effect is associated with life-threatening infections and may alter the chemotherapy schedule, thus impacting on early and long-term outcomes. Elderly breast cancer patients with impaired health status or advanced disease as well as patients undergoing dose-dense anthracycline/taxane- or docetaxel-based regimens have the highest risk of CIN. A careful assessment of the baseline risk for CIN allows the selection of patients who need primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) and/or antimicrobial agents. Neutropenic cancer patients may develop febrile neutropenia and CIN-related severe medical complications. Specific risk assessment scores, along with comprehensive clinical evaluation, are able to define a group of febrile patients with low risk for complications who can be safely treated as outpatients. Conversely, patients with higher risk of severe complications should be hospitalized and should receive intravenous antibiotic therapy with or without G-CSF.

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Section: Discussionmentioning

confidence: 99%

Management of Breast Cancer Patients with Chemotherapy-Induced Neutropenia or Febrile Neutropenia

et al. 2014

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“…Additional intangible yet important costs include parental and patient anxiety, travel costs, and missed time from school or work. In the oncology realm, research has identified effective cost savings when stratifying low‐risk patients with fever and neutropenia for conservative management, and the population of patients with AIN presents an optimal group for consideration of such conservative management …”

Section: Discussionmentioning

confidence: 99%

The cost of a “benign” condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia

Kirk

Grimes

Shelke

et al. 2019

Pediatric Blood & Cancer

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Background Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. Methods All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. Results Forty‐three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2‐85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. Conclusion At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less‐intensive, more cost‐effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.

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“…This translates to 15 patients per year, or 1 patient per 3 weeks. It has been suggested that more than two patients per week must be managed with this strategy in order for the development and maintenance of necessary infrastructure to be cost effective . Therefore, outpatient management of NF patients may not be practical at present at our regional cancer centre.…”

Section: Discussionmentioning

confidence: 99%

Infections, resistance patterns and antibiotic use in patients at a regional cancer centre

Silva

Jackson

Steer

2018

Internal Medicine Journal

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A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment

Abstract: 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.

Cited by 18 publications

References 27 publications

Management of Breast Cancer Patients with Chemotherapy-Induced Neutropenia or Febrile Neutropenia

Management of Breast Cancer Patients with Chemotherapy-Induced Neutropenia or Febrile Neutropenia

The cost of a “benign” condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia

Infections, resistance patterns and antibiotic use in patients at a regional cancer centre

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