Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Pediatr Blood Cancer. 2022 Jul;69(7):e29469. doi: 10.1002/pbc.29469. Epub 2021 Dec 2.
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.
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).
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$12,632 [95% CI: 12,496-12,767]). Overall, the home-based FN programme was the dominant strategy, being more effective (0.0011 QALY [95% CI: 0.0011-0.0012]) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care programme.
Compared to in-hospital FN care, the home-based FN programme is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the programme.
在家中使用口服或静脉抗生素治疗癌症并发发热性中性粒细胞减少症（FN）对儿童是安全且有效的。关于这种护理模式的经济影响的数据有限。我们评估了在一家三级儿科医院实施 FN 计划的成本效益，该计划包括为精心挑选的患者提供家庭静脉内抗生素。
构建了一个决策分析模型，以比较家庭 FN 计划的成本和结果，该计划包括使用临床决策规则根据严重感染风险对患者进行分层，以及使用疾病、化疗和患者水平因素对家庭资格进行分层。FN 风险分类和家庭资格的健康结果（生活质量）和概率基于 2017 年至 2019 年期间前瞻性收集的数据。患者层面的成本从医院行政记录中提取。成本效益表示为每质量调整生命年（QALY）的增量成本。
低风险患者家庭 FN 治疗的平均医疗保健费用为 7765 澳元（A$），而住院治疗为 20396 澳元（平均差异 A$12632 [95%CI：12496-12767]）。总体而言，家庭 FN 计划是主导策略，更有效（0.0011 QALY [95%CI：0.0011-0.0012]）且成本更低。模型的结果对家庭护理计划中符合条件的儿童比例最为敏感。
与住院 FN 护理相比，家庭 FN 计划具有成本效益，在家中照顾儿童的成本更低，从而节省了成本。随着更多符合家庭护理条件的患者纳入该计划，这些节省可能会增加。
