Cost-effectiveness and Improved Parent and Provider Satisfaction With Outpatient Management of Pediatric Oncology Patients, With Low-risk Fever and Neutropenia. Issue 7 (October 2018)

• Record Type: Journal Article
• Authors: Bavle, Abhishek; Grimes, Amanda; Zhao, Sibo; Zinn, Daniel; Jackson, Andrea; Patel, Binita; Porea, Timothy; Dutta, Ankhi; Russell, Heidi; Heczey, Andras
• Is Part Of: Journal of pediatric hematology/oncology. Volume 40:Issue 7(2018)
• Publication Date: 2018-10
• Subjects: low-risk fever and neutropenia -- pediatric oncology -- outpatient management -- cost-effectiveness -- parent satisfaction -- provider satisfaction; Pediatric hematology -- Periodicals; Tumors in children -- Periodicals; 618.9215
• DOI: 10.1097/MPH.0000000000001084
• Languages: English
• ISSNs: 1077-4114

Abstract

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.