Cost-effectiveness and Improved Parent and Provider Satisfaction With Outpatient Management of Pediatric Oncology Patients, With Low-risk Fever and Neutropenia

Abstract

On the basis of significant evidence for safety, the international pediatric fever and neutropenia committee recommends the identification and management of patients with "low-risk fever and neutropenia" (LRFN), outpatient with oral antibiotics, instead of traditional inpatient management. The aim of our study was to compare the cost-per-patient with these 2 strategies, and to evaluate parent and provider satisfaction with the outpatient management of LRFN. Between March 2016 and February 2017, 17 LRFN patients (median absolute neutrophil count, 90/μL) were managed at a single institution, per new guidelines. Fifteen patients were discharged on presentation or at 24 to 48 hours postadmission on oral levofloxacin, and 2 were inadvertently admitted off protocol. The mean cost of management for the postimplementation cohort was compared with a historic preimplementation control group. Satisfaction surveys were completed by parents and health care providers of LRFN patients. The mean total cost of an LRFN episode was $12,500 per patient preimplementation and $6168 postimplementation, a decrease of $6332 (51%) per patient. All parents surveyed found outpatient follow-up easy; most (12/14) parents and all (16/16) providers preferred outpatient management. Outpatient management of LRFN patients was less costly, and was preferred by a majority of parents and all health care providers, compared with traditional inpatient management.

Safety and efficacy of step‐down to oral outpatient treatment versus inpatient antimicrobial treatment in pediatric cancer patients with febrile neutropenia: A noninferiority multicenter randomized clinical trial

“…Finally, another advantage of outpatient treatment of low‐risk FN is cost reduction. Studies in Latin America and the United States have reported a mean cost reduction from US$265 to US$6332 per low‐risk FN episode, respectively 2,27 . In middle‐income countries, this saving may be greater and could be applied for other aspects of cancer treatment.…”

Pediatric Benign Neutropenia: Assessing Practice Preferences in Canada

“…Kirk et al13 found that children with autoimmune neutropenia had a high frequency of common childhood infections but no invasive bloodstream or life-threatening infections in a 3-year period. In the pediatric oncology population, studies have shown that outpatient management of low-risk patients with fever and neutropenia can be equally safe, more cost-effective, and associated with improved quality of life for both patients and families 18,19. With their low risk of serious bacterial infection, it follows that outpatient management of fever could be considered in patients with benign neutropenia who have a reassuring physical exam and laboratory studies.…”

The cost of a “benign” condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia

“…Additional intangible yet important costs include parental and patient anxiety, travel costs, and missed time from school or work. In the oncology realm, research has identified effective cost savings when stratifying low‐risk patients with fever and neutropenia for conservative management, and the population of patients with AIN presents an optimal group for consideration of such conservative management …”