Lowenthal R M, Piaszczyk A, Arthur G E, O'Malley S
Royal Hobart Hospital, Hobart, TAS.
Med J Aust. 1996 Aug 19;165(4):184-7. doi: 10.5694/j.1326-5377.1996.tb124921.x.
To assess the safety and to analyse the cost-effectiveness of home treatment, including cytotoxic chemotherapy, for cancer patients.
A restrospective overview of a home oncology nursing service over its first five years (1989-1994), and a detailed cost analysis over 12 months, firstly, by comparing direct costs of chemotherapy administration at home or in the hospital's day treatment ward and, secondly, by assessing the marginal cost of treating home care program patients in the hospital versus the total cost of the home care program.
Patients of the Haematology/Oncology Unit of a metropolitan teaching hospital treated either at home by an experienced oncology nurse, or in the hospital day care ward.
Patients were offered treatments, including chemotherapy, at home rather than in hospital.
Safety, assessed by the rate of major complications (i.e., requiring any patient to be admitted to hospital), and cost-effectiveness, assessed by comparing expenditure in the home and hospital settings.
Over five years, there were 5444 home visits to 424 patients, including 1688 chemotherapy administrations to 179 patients. Only two of the 424 patients decided against continuing in the home program once it had begun. There were no major complications. The average cost of home chemotherapy administration (excluding drugs) was $49.91, compared with $116.00 in hospital. The cost of treating patients at home was $5.09 per patient more than the "marginal cost" of treating these patients in the hospital.
Home anticancer chemotherapy is a safe and economically realistic alternative to traditional in-hospital treatment. Efforts should be made to overcome budgetary and administrative barriers to more widespread adoption of this model of care.
评估癌症患者居家治疗（包括细胞毒性化疗）的安全性并分析其成本效益。
对一项居家肿瘤护理服务的头五年（1989 - 1994年）进行回顾性概述，并在12个月内进行详细成本分析，首先，比较在家中或医院日间治疗病房进行化疗给药的直接成本，其次，评估在医院治疗居家护理项目患者的边际成本与居家护理项目的总成本。
一家大都市教学医院血液学/肿瘤学部的患者，他们要么由经验丰富的肿瘤护士在家中治疗，要么在医院日间护理病房治疗。
为患者提供在家而非在医院的治疗，包括化疗。
安全性通过主要并发症发生率（即需要任何患者住院）评估，成本效益通过比较在家和医院环境中的支出评估。
在五年期间，对424名患者进行了5444次家访，包括对179名患者进行了1688次化疗给药。424名患者中只有两名在居家项目开始后决定不再继续参与。没有发生重大并发症。在家进行化疗给药的平均成本（不包括药物）为49.91美元，而在医院为116.00美元。在家治疗患者的成本比在医院治疗这些患者的“边际成本”每位患者多5.09美元。
居家抗癌化疗是传统住院治疗的一种安全且经济可行的替代方案。应努力克服预算和行政障碍，以更广泛地采用这种护理模式。
