Cost-effectiveness of home-based care of febrile neutropenia in children with cancer.

Tew, M; De Abreu Lourenco, R; Gordon, JR; Thursky, KA; Slavin, MA; Babl, FA; Orme, L; Bryant, PA; Teh, BW; Dalziel, K; Haeusler, GM

Cost-effectiveness of home-based care of febrile neutropenia in children with cancer.

Tew, M De Abreu Lourenco, R

Gordon, JR Thursky, KA Slavin, MA Babl, FA Orme, L Bryant, PA Teh, BW Dalziel, K Haeusler, GM

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Publisher:: Wiley
Publication Type:: Journal Article
Citation:: Pediatr Blood Cancer, 2021, pp. e29469
Issue Date:: 2021-12-02

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Field	Value	Language
dc.contributor.author	Tew, M
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774
dc.contributor.author	Gordon, JR
dc.contributor.author	Thursky, KA
dc.contributor.author	Slavin, MA
dc.contributor.author	Babl, FA
dc.contributor.author	Orme, L
dc.contributor.author	Bryant, PA
dc.contributor.author	Teh, BW
dc.contributor.author	Dalziel, K
dc.contributor.author	Haeusler, GM
dc.date.accessioned	2022-01-17T23:37:08Z
dc.date.available	2021-11-01
dc.date.available	2022-01-17T23:37:08Z
dc.date.issued	2021-12-02
dc.identifier.citation	Pediatr Blood Cancer, 2021, pp. e29469
dc.identifier.issn	1545-5009
dc.identifier.issn	1545-5017
dc.identifier.uri	http://hdl.handle.net/10453/153234
dc.description.abstract	INTRODUCTION: Home-based treatment of febrile neutropenia (FN) in children with cancer with oral or intravenous antibiotics is safe and effective. There are limited data on the economic impact of this model of care. We evaluated the cost-effectiveness of implementing an FN programme, incorporating home-based intravenous antibiotics for carefully selected patients, in a tertiary paediatric hospital. METHODS: A decision analytic model was constructed to compare costs and outcomes of the home-based FN programme, with usual in-hospital treatment with intravenous antibiotics. The programme included a clinical decision rule to stratify patients by risk for severe infection and home-based eligibility criteria using disease, chemotherapy and patient-level factors. Health outcomes (quality of life) and probabilities of FN risk classification and home-based eligibility were based on prospectively collected data between 2017 and 2019. Patient-level costs were extracted from hospital administrative records. Cost-effectiveness was expressed as the incremental cost per quality-adjusted life year (QALY). FINDINGS: The mean health care cost of home-based FN treatment in low-risk patients was Australian dollars (A$) 7765 per patient compared to A$20,396 for in-hospital treatment (mean difference A$12,632 [95% CI: 12,496-12,767]). Overall, the home-based FN programme was the dominant strategy, being more effective (0.0011 QALY [95% CI: 0.0011-0.0012]) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care programme. CONCLUSION: Compared to in-hospital FN care, the home-based FN programme is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the programme.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Wiley
dc.relation.ispartof	Pediatr Blood Cancer
dc.relation.isbasedon	10.1002/pbc.29469
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1112 Oncology and Carcinogenesis, 1114 Paediatrics and Reproductive Medicine
dc.subject.classification	Oncology & Carcinogenesis
dc.title	Cost-effectiveness of home-based care of febrile neutropenia in children with cancer.
dc.type	Journal Article
utslib.location.activity	United States
utslib.for	1103 Clinical Sciences
utslib.for	1112 Oncology and Carcinogenesis
utslib.for	1114 Paediatrics and Reproductive Medicine
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
dc.date.updated	2022-01-17T23:37:07Z
pubs.publication-status	Published online

Abstract:

INTRODUCTION: Home-based treatment of febrile neutropenia (FN) in children with cancer with oral or intravenous antibiotics is safe and effective. There are limited data on the economic impact of this model of care. We evaluated the cost-effectiveness of implementing an FN programme, incorporating home-based intravenous antibiotics for carefully selected patients, in a tertiary paediatric hospital. METHODS: A decision analytic model was constructed to compare costs and outcomes of the home-based FN programme, with usual in-hospital treatment with intravenous antibiotics. The programme included a clinical decision rule to stratify patients by risk for severe infection and home-based eligibility criteria using disease, chemotherapy and patient-level factors. Health outcomes (quality of life) and probabilities of FN risk classification and home-based eligibility were based on prospectively collected data between 2017 and 2019. Patient-level costs were extracted from hospital administrative records. Cost-effectiveness was expressed as the incremental cost per quality-adjusted life year (QALY). FINDINGS: The mean health care cost of home-based FN treatment in low-risk patients was Australian dollars (A$) 7765 per patient compared to A$20,396 for in-hospital treatment (mean difference A$12,632 [95% CI: 12,496-12,767]). Overall, the home-based FN programme was the dominant strategy, being more effective (0.0011 QALY [95% CI: 0.0011-0.0012]) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care programme. CONCLUSION: Compared to in-hospital FN care, the home-based FN programme is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the programme.

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http://hdl.handle.net/10453/153234