Holdsworth M T, Duncan M H
College of Pharmacy, University of New Mexico, Albuquerque 87131-1066, USA.
Am J Health Syst Pharm. 1995 Oct 1;52(19 Suppl 4):S15-8. doi: 10.1093/ajhp/52.19_Suppl_4.S15.
A case study of the clinical and economic impact of filgrastim in cancer patients in the home care setting is described. The risk of febrile neutropenia is greatly reduced when filgrastim therapy is begun prophylactically after a course of antineoplastic drug therapy. Such use of filgrastim may also reduce the need for hospitalization, prevent mucositis, and enable the next course of chemotherapy to be administered on schedule. Investigators at the University of New Mexico, noting studies showing merit in early hospital discharge of pediatric cancer patients with febrile neutropenia, decided to take the approach a step further by treatment febrile neutropenia entirely at home. Patients seen in the pediatric oncology clinic at the university hospital were considered candidates for home treatment if they had stable vital signs, were already receiving filgrastim after the completion of cancer chemotherapy, and lived within one hour of the hospital. Six cancer patients 2-17 years of age were studied between August 1992 and February 1994. These patients had 16 episodes of febrile neutropenia that were treated at home. The drug regimen consisted of prophylactic filgrastim (begun the day after completion of a course of antineoplastic therapy) and ceftazidime (when febrile neutropenia developed). None of the children were readmitted to the hospital. Infections resolved within 12 days in all cases. The total charge for treating the 16 episodes at home was $22,400 (drug charge for ceftazidime, visits by nurses, infusion-pump rental, and ancillary charges). The total charge for hospital treatment of these episodes would be $112,924 (bed charge and pharmacy charge). The difference suggests a potential savings of $90,524 from home care for this small group of patients. Treating febrile neutropenia in pediatric cancer patients at home is effective and cost-efficient if the patients are clinically stable and prophylactic filgrastim therapy has been started after the completion of cancer chemotherapy.
本文描述了一项关于非格司亭对居家护理癌症患者的临床及经济影响的案例研究。在完成一轮抗肿瘤药物治疗后预防性开始非格司亭治疗，可大幅降低发热性中性粒细胞减少症的风险。这种使用非格司亭的方式还可能减少住院需求、预防粘膜炎，并使下一疗程化疗能够按时进行。新墨西哥大学的研究人员注意到，有研究表明，对于患有发热性中性粒细胞减少症的儿科癌症患者，早期出院有其益处，于是决定更进一步，完全在家中治疗发热性中性粒细胞减少症。如果大学医院儿科肿瘤门诊的患者生命体征稳定，在完成癌症化疗后已在接受非格司亭治疗，且居住在距离医院一小时路程内，则被视为居家治疗的候选对象。在1992年8月至1994年2月期间，对6名2至17岁的癌症患者进行了研究。这些患者有16次发热性中性粒细胞减少症发作，均在家中接受治疗。药物治疗方案包括预防性非格司亭（在一轮抗肿瘤治疗完成后的次日开始使用）和头孢他啶（在出现发热性中性粒细胞减少症时使用）。所有儿童均未再次住院。所有病例的感染均在12天内得到解决。在家中治疗这16次发作的总费用为22400美元（头孢他啶药物费用、护士家访费用、输液泵租赁费用及辅助费用）。这些发作在医院治疗的总费用将为112924美元（床位费用和药房费用）。这一差异表明，对这一小群患者进行居家护理可能节省90524美元。如果儿科癌症患者临床稳定，且在完成癌症化疗后已开始预防性非格司亭治疗，那么在家中治疗发热性中性粒细胞减少症是有效且具有成本效益的。
