Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial

Abstract

Purpose: For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation.

Methods: We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008.

Results: Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work.

Conclusion: Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.

Fig 1.

CONSORT diagram. (*) The study design did not collect these data, in part because the number of patients reviewed varied according to the screening approach. At the Boston sites, we screened approximately 10 patients for each eligible patient. (†) We did not keep the data. In Boston, the average acceptance rate (1-refusal rate) was approximately 30%, increasing from 15% in the first year of the study to 45% in the final year, when the concept of discharge home was more familiar.