儿童癌症患者发热和中性粒细胞减少症门诊降阶梯管理的经济影响：成本最小化分析。
Economic implications of step-down outpatient management for fever and neutropenia episodes in pediatric cancer patients: a cost minimization analysis.
机构信息
Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
Center of Economics and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
出版信息
BMC Health Serv Res. 2024 Aug 24;24(1):981. doi: 10.1186/s12913-024-11442-w.
BACKGROUND
The management of febrile neutropenia (FN) in pediatric cancer patients has traditionally been conducted in a hospital setting. However, recent evidence has indicated that outpatient management of FN can be equally effective compared to inpatient care. Based on this evidence, we conducted a cost-minimization analysis (CMA) specifically focused on pediatric cancer patients in Mexico.
METHODS
A piggy-back study was conducted during the execution of a non-inferiority clinical trial that compared outpatient treatment to inpatient treatment for FN in children with cancer. A CMA was performed from a societal perspective using patient-level data. In the previous study, we observed that step-down oral outpatient management of low-risk FN was as safe and effective as inpatient intravenous management. Direct and indirect costs were collected prospectively. The costs were adjusted for inflation and converted to US dollars, with values standardized to July 2022 costs. Statistical analysis using bootstrap methods was employed to obtain robust estimations for decision-making within the Mexican public health care system.
RESULTS
A total of 117 FN episodes were analyzed, with 60 in the outpatient group and 57 in the inpatient group; however, complete cost data were available for only 115 FN episodes. The analysis revealed an average savings of $1,087 per FN episode managed on an outpatient basis, representing a significant 92% reduction in total cost per FN episode compared to inpatient treatment. Length of hospital stay and inpatient consultations emerged as the primary cost drivers within the inpatient care group.
CONCLUSION
This CMA demonstrates that the step-down outpatient management approach is cost-saving when compared to inpatient management of FN in pediatric cancer patients. The mean difference observed between the treatment groups provides support for decision-making within the public health care system, as outpatient management of FN allows for substantial cost savings without compromising patient health.
背景
在儿科癌症患者中，发热性中性粒细胞减少症（FN）的管理传统上是在医院环境中进行的。然而，最近的证据表明，FN 的门诊管理与住院护理同样有效。基于这一证据，我们专门针对墨西哥的儿科癌症患者进行了一项成本最小化分析（CMA）。
方法
在一项非劣效性临床试验执行期间进行了一项附加研究，该研究比较了癌症儿童 FN 的门诊治疗与住院治疗。从社会角度进行了 CMA，并使用患者水平的数据进行了分析。在之前的研究中，我们观察到低危 FN 的降级口服门诊管理与住院静脉内管理一样安全有效。前瞻性收集直接和间接成本。这些成本按通胀进行了调整，并转换为美元，将值标准化为 2022 年 7 月的成本。使用自举法进行了统计分析，以获得墨西哥公共卫生保健系统内决策的稳健估计。
结果
共分析了 117 例 FN 发作，其中 60 例在门诊组，57 例在住院组；然而，只有 115 例 FN 发作有完整的成本数据。分析显示，每例 FN 门诊管理平均节省 1087 美元，与住院治疗相比，每例 FN 发作的总成本降低了 92%。住院时间和住院咨询是住院治疗组的主要成本驱动因素。
结论
这项 CMA 表明，与 FN 住院管理相比，儿科癌症患者的降级门诊管理方法具有成本效益。治疗组之间观察到的平均差异为公共卫生保健系统内的决策提供了支持，因为 FN 的门诊管理允许在不影响患者健康的情况下大幅节省成本。
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