Treatment strategies for low-risk febrile neutropenia in adult cancer patients: A cost-utility analysis.

Abstract

6102 Background: Febrile neutropenia remains a frequent complication of chemotherapy for adult cancer patients. There is uncertainty as to whether low-risk episodes are best managed in the inpatient or outpatient setting. Methods: A cost-utility model was created to compare four treatment strategies for low-risk febrile neutropenia in adult cancer patients. Event probabilities were retrieved from a formal systematic review and meta-analysis. Utilities were obtained from adult cancer patients. The base case was assumed to be an adult cancer patient with a first episode of low- risk febrile neutropenia. The model used a healthcare payer perspective in Ontario/Canada, and a time horizon of 30 days corresponding to one episode of febrile neutropenia. Four treatment strategies were evaluated: (1) entire treatment in hospital with intravenous antibiotics (HospIV), (2) early discharge strategy consisting of 48 hours inpatient observation with intravenous antibiotics, subsequently followed by oral outpatient treatment (EarlyDC), (3) entire outpatient management with intravenous antibiotics (HomeIV), and (4) entire outpatient management with oral antibiotics (HomePO). Outcome measures were quality-adjusted life months (QALMs), costs, and incremental cost-effectiveness ratios (ICER). Results: HomeIV was associated with both better health outcomes (0.797 QALM) and lower costs ($2,129) as compared to the other 3 strategies. Since HomePO (0.763 QALM; $2,309), EarlyDC (0.664 QALM; 5,647), and HospIV (0.661 QALM; $13,517) were all dominated, ICERs could not be determined. These results were sensitive to several event probabilities, utilities and costs. Beyond certain thresholds, the best strategy changed from HomeIV to the HomePO strategy. However, HospIV or EarlyDC management were never the preferred strategy in sensitivity analyses. Conclusions: For adult cancer patients with a first episode of febrile neutropenia, outpatient strategies were more effective and less costly compared with standard inpatient management. However, uncertainty remains whether intravenous or oral treatment might be the preferable route of drug administration in an ambulatory setting. No significant financial relationships to disclose.