Case-Control Comparison of At-Home to Total Hospital Care for Autologous Stem-Cell Transplantation for Hematologic Malignancies

Abstract

Results of at-home ASCT with prophylactic administration of ceftriaxone and domiciliary treatment of febrile neutropenia with piperacillin and tazobactam are highly satisfactory and significantly cheaper compared with those obtained with conventional in-hospital ASCT.

Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs

“…Although it is difficult to compare costs' analyses between countries, to date all studies agree that outpatient programs lead to cost savings-from 7 to 47%. 6,9,11,14 In our study, shifting from inpatient to early discharge programs created cost savings of 19% when considering the patients actually discharged early. Considering all the patients randomized in the early discharge program, our early discharge program showed a mean cost per patient only 6% inferior to that for the conventional inpatient group, reflecting less attractive savings than those found in other studies.…”

“…Considering all the patients randomized in the early discharge program, our early discharge program showed a mean cost per patient only 6% inferior to that for the conventional inpatient group, reflecting less attractive savings than those found in other studies. 6,9,11 The strength of our results lies in the study's design. Unlike the present study, previously published studies have not been randomized in nature and consequently the resources associated with the treatment of the proportion of patients not willing or not able to be discharged early were not included.…”

“…6) to 90% 12 ). Fernandez et al 6 observed a rate of readmission of 8%, but their early discharged patients were selected on the basis of their ECOG status (ECOGo2). Westermann et al 22 showed a 70% readmission rate, which is quite comparable to our 86%.…”

“…antibiotics between the group A and group B were observed, which is in-line with other studies. 6,9,23 Antibiotics prophylaxis has been used in most other outpatient and early discharge programs. Our results suggest that the lack of prophylaxis did not result in an unacceptable increase in infectious complications for outpatients.…”

“…Over the past decade, a number of studies have investigated the efficacy, safety and cost advantages of reduced hospitalization for auto-SCT. [5][6][7][8][9][10][11][12][13][14][15][16][17] During this time several models of outpatient (home-and clinic-based or daily clinic-based) and early discharge care (with or without planned readmission) have emerged. 18 Studies usually conclude that HDCT is feasible and safe in the outpatient setting, thanks to the use of hematopoietic growth factors and antimicrobial prophylaxis, which lower aplasia related complications.…”