Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia

Linda S. Elting, Charles Lu, Carmelita P. Escalante, Sharon H. Giordano, Jonathan Trent, Catherine Cooksley, Elenir B C Avritscher, Ya Chen Tina Shih, Joe Ensor, B. Nebiyou Bekele, Richard J. Gralla, James A. Talcott, Kenneth Rolston

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Purpose: We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods: A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results: Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion: Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

Original languageEnglish
Pages (from-to)606-611
Number of pages6
JournalJournal of Clinical Oncology
Volume26
Issue number4
DOIs
StatePublished - Feb 1 2008
Externally publishedYes

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Febrile Neutropenia
Inpatients
Outpatients
Costs and Cost Analysis
Risk Management
Anti-Bacterial Agents
Critical Pathways
Telephone
Caregivers
Signs and Symptoms
Medical Records
Intensive Care Units
Hospital Emergency Service
Hospitalization
Research Personnel

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Elting, L. S., Lu, C., Escalante, C. P., Giordano, S. H., Trent, J., Cooksley, C., ... Rolston, K. (2008). Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. Journal of Clinical Oncology, 26(4), 606-611. https://doi.org/10.1200/JCO.2007.13.8222

Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. / Elting, Linda S.; Lu, Charles; Escalante, Carmelita P.; Giordano, Sharon H.; Trent, Jonathan; Cooksley, Catherine; Avritscher, Elenir B C; Shih, Ya Chen Tina; Ensor, Joe; Bekele, B. Nebiyou; Gralla, Richard J.; Talcott, James A.; Rolston, Kenneth.

In: Journal of Clinical Oncology, Vol. 26, No. 4, 01.02.2008, p. 606-611.

Research output: Contribution to journalArticle

Elting, LS, Lu, C, Escalante, CP, Giordano, SH, Trent, J, Cooksley, C, Avritscher, EBC, Shih, YCT, Ensor, J, Bekele, BN, Gralla, RJ, Talcott, JA & Rolston, K 2008, 'Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia', Journal of Clinical Oncology, vol. 26, no. 4, pp. 606-611. https://doi.org/10.1200/JCO.2007.13.8222
Elting, Linda S. ; Lu, Charles ; Escalante, Carmelita P. ; Giordano, Sharon H. ; Trent, Jonathan ; Cooksley, Catherine ; Avritscher, Elenir B C ; Shih, Ya Chen Tina ; Ensor, Joe ; Bekele, B. Nebiyou ; Gralla, Richard J. ; Talcott, James A. ; Rolston, Kenneth. / Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 4. pp. 606-611.
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AU - Trent, Jonathan

AU - Cooksley, Catherine

AU - Avritscher, Elenir B C

AU - Shih, Ya Chen Tina

AU - Ensor, Joe

AU - Bekele, B. Nebiyou

AU - Gralla, Richard J.

AU - Talcott, James A.

AU - Rolston, Kenneth

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N2 - Purpose: We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods: A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results: Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion: Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

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