Home and Community Care Digest
Home-based treatment of children with chemotherapy induced febrile neutropenia is more economical than hospital-based treatment.
Methods: Investigators compared use of resources and total costs associated with the treatment of an FN episode in programs at the University of Arizona Medical Center and the University of New Mexico Children's Hospital (UNM). The former program was primarily hospital-based while the latter was an intensive home-based program. Data were obtained through a retrospective chart review of patients admitted before 1998. The study population included children aged 1 to 19 years with low-risk FN episodes. It thus excluded patients who experienced: 1) chronic neutropenia; 2) FN as an inpatient; 3) poor control of underlying cancer and 4) a serious concurrent comorbidity. Only patients living within a 1-hour drive of the hospital who had a parent or a legal guardian that could provide 24-hour supervision were allowed to participate in the home-based program at UNM. All health care resources including physician visits, home-care visits, laboratory tests, medication, etc. were included in the analysis but costs to the patients and their families were not calculated.
Findings: The records of 27 children in the hospital-based program were compared to 36 children in the home-based program. There were 72 FN episodes in both groups. Children in the hospital-based program spent a median of 6 days in hospital and 0 days at home, while children in the home-based program spent a median of 0 days in hospital and 7 days at home. The mean and median cost per FN episode was $US5155 and $US3499 less in the home-based program than in the hospital-based program. Randomization was not possible, but patients in both groups had similar demographic characteristics and depth of neutropenia. The hospital-based group received a significant higher number of lab tests, while the home-based cohort received significantly more filgrastim and accrued higher antibiotic charges. These differences, however, may have been driven by setting-specific procedures rather than clinical need. Recovery rates and time to resolution of infectious symptoms were not different between the two groups.
Conclusion: Overall, the home-based programs saved the health care system money without sacrificing patient safety in this patient population. Successful implementation of home-based programs, however, requires a home care agency with the proper facilities and the ability to work closely with the hospital. In addition, adequate facilities, proper sanitation and 24-hour supervision by a parental caregiver must be available for the patient in the home environment.
Reference: Raisch DW, Holdsworth MT, Winter SS, et al. Economic comparison of home-care-based treatment of chemotherapy-induced febrile neutropenia in children. Value in Health 2003; 6(2) 158 - 166.
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