Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: Comparing hospital and home care

Abstract

Hospital treatment was more effective but more expensive than home treatment. Potential methods to improve outcome at home should be considered but these may have resource implications.

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…service comparators, including inpatient care and early discharge with oral treatment. The patient populations were varied too, including those with surgical site infections, 66 MRSA-complicated SSTIs, 136 cystic fibrosis, 53 febrile neutropenia 65 and prosthetic joint infections. 24 Of the studies identified in the review, only one presented an incremental cost-utility analysis.…”

“…Five of the studies did not specify the OPAT model that was being used, 29,48,[52][53][54] whereas six others reported combined results for multiple OPAT models. 48,[52][53][54][55] Synthesis of the findings from these studies indicates that, regardless of the OPAT model used, there is little impact on the duration of i.v. antibiotic treatment in comparison with inpatient treatment 12,22,25,[41][42][43][56][57][58] (see Appendix 1, Table 32).…”

“…antibiotic treatment administered mostly in hospital was more effective but more costly than treatment administered mostly at home. 53 This improved clinical effectiveness could be achieved only with the input of considerable additional resources (between £46,000 and £73,000 per patient at 2002 prices). However, when the strictest definition of effectiveness was applied (≤ 0% decline in lung function), hospital treatment was unlikely ever to be cost-effective.…”

Location and Duration of Treatment of Cystic Fibrosis Respiratory Exacerbations Do Not Affect Outcomes

“…Outpatient intravenous therapy has gained widespread acceptance because of its advantages over hospitalization, including fewer absences from school or work and less disruption of family life (4-7), decreased costs per treatment course (4)(5)(6)(7)(8), and high patient satisfaction (4)(5)(6). On the other hand, longterm costs may not be reduced in the outpatient setting because of the need for longer and more frequent courses of antibiotics (9), and quality of life may not be better across all domains (7,10).…”

A Life Course Perspective on Health Trajectories and Transitions

“…An appropriate policy response might be to ensure that mechanisms are put in place to facilitate equitable delivery of treatments at home, wherever possible. Home care has been shown to be as effective as hospital treatment for some patients (van Aalderen et al 1995), but not others (Bosworth and Nielson 1997;Thornton et al 2005). It is also less expensive and may be associated with improvement in quality of life (van Aalderen et al 1995).…”