Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer
Cost-effectiveness of Outpatient Management for Febrile Neutropenia in Children With Cancer
复制标题
DOI：
10.1542/peds.2010-0734
复制
发表时间：
2011-02-01
期刊：
影响因子：
8
通讯作者：
Sung, Lillian
中科院分区：
文献类型：
--
作者：
Teuffel, Oliver;Amir, Eitan;Sung, Lillian
目的：住院管理仍然是治疗癌症儿童发热性中性粒细胞减少症（FN）的标准治疗方法。然而，临床数据表明，门诊管理可能是一个安全有效的替代低风险FN epission.METHODS：一个成本效用模型，比较4低风险FN的治疗策略。基础病例考虑患有低风险FN的儿科癌症患者。该模型使用了医疗保健支付者的观点和1 FN事件的时间范围。评价了四种治疗策略：（1）在医院内使用静脉注射抗生素进行全程治疗（HospIV）;（2）早期出院，包括使用静脉注射抗生素进行48小时住院观察，然后进行口服门诊治疗（EarlyDC）;（3）使用静脉注射抗生素进行完全门诊管理（HomeIV）;以及（4）使用口服抗生素进行完全门诊管理（HomePO）。结果的措施是质量调整FN发作（QAFNEs），成本（加元），和增量成本效益比。参数的不确定性进行了评估与概率敏感性analysis.RESULTS：最具成本效益的策略是HomeIV。与HomePO相比，它节省了成本（2732美元vs 2757美元），并且更有效（0.66 vs 0.55 QAFNE）。EarlyDC比HomeIV稍微有效（0.68 QAFNE），但明显更昂贵（5579美元），这导致了不可接受的高增量成本效益比，每个QAFNE超过130 000美元。HospIV是最不具成本效益的策略，因为它是更昂贵的（14 493美元）和更有效的（0.65 QAFNE）比EarlyDC.CONCLUSION：这个决策分析模型的结果表明，住院管理的成本大幅上升的安全性和有效性的考虑或患者/家长的喜好的基础上是不合理的。儿科2011;127：e279-e286
OBJECTIVE: Inpatient management remains the standard of care for treatment of febrile neutropenia (FN) in children with cancer. Clinical data suggest, however, that outpatient management might be a safe and efficacious alternative for patients with low-risk FN episodes.METHODS: A cost-utility model was created to compare 4 treatment strategies for low-risk FN. The base case considered pediatric cancer patients with low-risk FN. The model used a health care payer's perspective and a time horizon of 1 FN episode. Four treatment strategies were evaluated: (1) entire treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge consisting of 48 hours of inpatient observation with intravenous antibiotics followed by oral outpatient treatment (EarlyDC); (3) entirely outpatient management with intravenous antibiotics (HomeIV); and (4) entirely outpatient management with oral antibiotics (HomePO). Outcome measures were quality-adjusted FN episodes (QAFNEs), costs (Canadian dollars), and incremental cost-effectiveness ratios. Parameter uncertainty was assessed with probabilistic sensitivity analyses.RESULTS: The most cost-effective strategy was HomeIV. It was cost-saving ($2732 vs $2757) and more effective (0.66 vs 0.55 QAFNE) as compared with HomePO. EarlyDC was slightly more effective (0.68 QAFNE) but significantly more expensive ($5579) than HomeIV, which resulted in an unacceptably high incremental cost-effectiveness ratio of more than $130 000 per QAFNE. HospIV was the least cost-effective strategy because it was more expensive ($14 493) and less effective (0.65 QAFNE) than EarlyDC.CONCLUSION: The findings of this decision-analytic model indicate that the substantially higher costs of inpatient management cannot be justified on the basis of safety and efficacy considerations or patient/parent preferences. Pediatrics 2011;127:e279-e286