Division of Haematology/Oncology, Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M6G 1X8.
Br J Cancer. 2011 Apr 26;104(9):1377-83. doi: 10.1038/bjc.2011.101. Epub 2011 Apr 5.
There is uncertainty whether low-risk episodes of febrile neutropaenia (FN) in adult cancer patients are best managed in the in- or outpatient setting.
A Monte Carlo cost-utility model was created to compare four treatment strategies for low-risk FN: (1) treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge after 48 h in-patient observation, followed by oral outpatient treatment (EarlyDC); (3) outpatient management with IV antibiotics (HomeIV); and (4) outpatient management with oral antibiotics (HomePO). The model used a health-care payer perspective and a time horizon of one FN episode. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollars) and incremental cost-effectiveness ratios (ICER). Parameter uncertainty was assessed with probabilistic sensitivity analyses.
HomePO was cost saving ($3470 vs $4183), but less effective (0.65 QAFNE vs 0.72 QAFNE) than HomeIV. The corresponding ICER was $10,186 per QAFNE. Both EarlyDC ($6115; 0.66 QAFNE) and HospIV ($13,557; 0.62 QAFNE) were dominated strategies. At a willingness-to-pay (WTP) threshold of $4,000 per QAFNE, HomePO and HomeIV were cost effective in 54 and 38% of simulations, respectively.
For adult cancer patients with an episode of low-risk FN, treatment in hospital is more expensive and less effective than outpatient strategies.
低危发热性中性粒细胞减少症（FN）发作的成年癌症患者，在门诊或住院环境下治疗，哪种方案最佳尚存争议。
采用蒙特卡罗成本效用模型，比较了低危 FN 四种治疗策略：（1）住院静脉使用抗生素（HospIV）治疗；（2）48 小时住院观察后提前出院，然后门诊口服治疗（EarlyDC）；（3）门诊静脉使用抗生素（HomeIV）治疗；（4）门诊口服抗生素（HomePO）治疗。模型采用医疗保健支付者视角，时间范围为一个 FN 发作。结局指标为质量调整 FN 发作（QAFNE）、成本（加元）和增量成本效用比（ICER）。采用概率敏感性分析评估参数不确定性。
HomePO 方案更节省成本（$3470 比 $4183），但效果较差（0.65 QAFNE 比 0.72 QAFNE）。相应的 ICER 为每 QAFNE 增加$10,186。EarlyDC（$6115；0.66 QAFNE）和 HospIV（$13,557；0.62 QAFNE）均为劣效策略。在 WTP 阈值为每 QAFNE 增加$4,000 时，HomePO 和 HomeIV 方案在 54%和 38%的模拟中具有成本效益。
对于患有低危 FN 的成年癌症患者，住院治疗比门诊治疗方案更昂贵，效果更差。
