Factors influencing patient preferences for outpatient treatment of febrile neutropenia.

Abstract

6041 Background: Febrile neutropenia (FN) is a serious hematologic toxicity of cancer chemotherapy. Studies show that patients at low risk for FN complications can be treated safely and effectively at home instead of in hospital. The objective of this study was to evaluate factors affecting patient preferences for outpatient treatment of FN using a discrete choice experiment (DCE). Methods: We asked patients with non-Hodgkin lymphoma undergoing chemotherapy to complete a self-administered DCE questionnaire based on the following attributes: out-of-pocket costs (levels: $10, $25, $50, $100); unpaid caregiver time required daily (levels: 1 hour, 2 hours, 4 hours, 8 hours); and probability of return to hospital (levels: 5%, 10%, 20%, 50%). Using these attributes, we generated sets of paired scenarios based on an orthogonal main effects plan. Ten paired scenarios were included in the final questionnaire. For each pair, we asked participants to select the scenario they preferred, to assess how they traded off between attributes. We analyzed results using logistic regression. Results: Seventy-eight patients completed the questionnaire. The mean age of participants was 59.6 years (range: 23.7 - 87.2 years) and 46 (59%) were male. Eleven patients (14%) had been previously hospitalized for treatment of FN. Six hundred and ten paired scenarios were included in the analysis. The regression coefficients for all three attributes were statistically significant (p<0.01), indicating that they all influence the willingness of patients to accept outpatient FN therapy. For every $20 increase in out-of-pocket costs the adjusted odds ratio (OR) of accepting outpatient care was 0.84 (95% CI: 0.77, 0.91); for every 1 hour increase in unpaid caregiver time required daily the adjusted OR was 0.92 (95% CI: 0.87, 0.97); and for every 10% increase in probability of return to hospital the adjusted OR was 0.49 (95% CI: 0.45, 0.53). Conclusions: Out-of-pocket costs, unpaid caregiver time required, and probability of return to hospital all significantly influence patients’ willingness to accept outpatient treatment of FN. Healthcare decision makers could use this information to design and implement programs for delivery of outpatient care for FN.