A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment
Senthil Lingaratnam A P , Leon J. Worth B , Monica A. Slavin B C , Craig A. Bennett D , Suzanne W. Kirsa A , John F. Seymour E , Andrew Dalton F G , Bogda Koczwara H I , H. Miles Prince E J K , Mary O’Reilly J L M , Linda Mileshkin E , Jeff Szer N O and Karin A. Thursky B CA Pharmacy Department, Peter MacCallum Cancer Centre, 1 St Andrew’s Place, East Melbourne, VIC 3002, Australia.
B Department of Infectious Diseases, Peter MacCallum Cancer Centre, 1 St Andrew’s Place, East Melbourne, VIC 3002, Australia.
C Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
D Peter MacCallum Cancer Centre, St Andrew’s Place, East Melbourne, VIC 3002, Australia.
E Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, 1 St Andrew’s Place, East Melbourne, VIC 3002, Australia.
F Melbourne School of Population Health, 207 Bouverie Street, The University of Melbourne, VIC 3010, Australia.
G ADhealth Pty Ltd, 3 Norfolk Road, Surrey Hills, VIC 3127, Australia.
H Department of Medical Oncology, Flinders Medical Centre, Flinders Drive, Adelaide, SA 5042, Australia.
I Medical Oncology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
J Cabrini Medical Centre, 183 Wattletree Road, Malvern, VIC 3144, Australia.
K St Vincent’s Hospital, Victoria Parade, Fitzroy, VIC 3065, Australia.
L Department of Infectious Diseases, PO Box 94, Box Hill, VIC 3128, Australia.
M Infectious Diseases and Infection Control, Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill, VIC 3128, Australia.
N Department of Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia.
O Western & Central Melbourne Integrated Cancer Services, Locked bag 1, A’Beckett Street, VIC 8006, Australia.
P Corresponding author. Email: senthil.lingaratnam@petermac.org
Australian Health Review 35(4) 491-500 https://doi.org/10.1071/AH10951
Submitted: 9 August 2010 Accepted: 13 January 2011 Published: 28 October 2011
Abstract
Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration.
Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care.
Results. The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of ‘low-risk’ febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7–55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7–39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach.
Conclusion. This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing ‘low-risk’ febrile neutropenic patients.
What is known about the topic? Febrile neutropenia is a common complication of chemotherapy for patients with cancer. There is high level evidence supporting the use of ambulatory care strategies to manage patients with febrile neutropenia who are deemed to be at low risk of developing medical complications.
What does this paper add? This paper highlights a cost structure for an adequately equipped and cost-effective ambulatory care strategy suitable for Australian hospitals to manage patients with low-risk febrile neutropenia.
What are the implications for practitioners? The strategy advocated in this paper affords eligible patients the choice of early discharge from hospital. It advocates for improved resource utilisation and expansion of outpatient services in order to minimise opportunity costs faced by cancer treatment facilities.
Additional keywords: ambulatory care, costs, economics.
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