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An analysis of the resource use and costs of febrile neutropenia events in pediatric cancer patients in Australia |
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| Authors: | Constanza Vargas Gabrielle M. Haeusler Monica A. Slavin Franz E. Babl Francoise Mechinaud Robert Phillips Karin Thursky Richard De Abreu Lourenco the Australian PICNICC Study Group |
| Affiliation: | 1. Centre for Health Economics Research and Evaluation, University of Technology Sydney, Broadway, New South Wales, Australia;2. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia The Paediatric Integrated Cancer Service, Victoria State Government, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Medicine, University of Melbourne, Parkville, Victoria, Australia;3. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia;4. Department of Medicine, University of Melbourne, Parkville, Victoria, Australia Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia;5. Unité d'hématologie Immunologie Pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France;6. Centre for Reviews and Dissemination, University of York, York, UK;7. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, Australia |
| Abstract: | BackgroundFebrile neutropenia (FN) in children with cancer generally requires in-hospital care, but low-risk patients may be successfully managed in an outpatient setting, potentially reducing the overall healthcare costs. Updated data on the costs of FN care are lacking.MethodsA bottom-up microcosting analysis was conducted from the healthcare system perspective using data collected alongside the Australian PICNICC (Predicting Infectious Complications of Neutropenic sepsis In Children with Cancer) study. Inpatient costs were accessed from hospital administrative records and outpatient costs from Medicare data. Costs were stratified by risk status (low/high risk) according to the PICNICC criteria. Estimated mean costs were obtained through bootstrapping and using a linear model to account for multiple events across individuals and other clinical factors that may impact costs.ResultsThe total costs of FN care were significantly higher for FN events classified as high-risk ($17,827, 95% confidence interval [CI]: $17,193–$18,461) compared to low-risk ($10,574, 95% CI: $9818–$11,330). In-hospital costs were significantly higher for high-risk compared to low-risk events, despite no differences in the cost structure, mean cost per day, and pattern of resource use. Hospital length of stay (LOS) was the only modifiable factor significantly associated with total costs of care. Excluding antineoplastics, antimicrobials are the most commonly used medications in the inpatient and outpatient setting for the overall period of analysis.ConclusionThe FN costs are driven by in-hospital admission and LOS. This suggests that the outpatient management of low-risk patients is likely to reduce the in-hospital cost of treating an FN event. Further research will determine if shifting the cost to the outpatient setting remains cost-effective overall. |
| Keywords: | costs febrile neutropenia pediatric cancer |