Supportive Care in Cancer

, Volume 26, Issue 3, pp 997–1003 | Cite as

Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre

  • Benjamin W. TehEmail author
  • Christine Brown
  • Trish Joyce
  • Leon J. Worth
  • Monica A. Slavin
  • Karin A. Thursky
Original Article



Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period.


Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons.


Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported.


Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.


Low risk Febrile neutropenia Safety Cost benefit 



We would like to thank Mr. Senthil Lingaratnam for his assistance with the data collected for the historical cohort and Ms. Yew Sok-Wee for her assistance with the data for health costings. Dr. Benjamin W Teh is supported by the Peter MacCallum Cancer Centre clinical research fellowship.


Funding for the program and this study was provided by the Western and Central Melbourne Integrated Cancer Service.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Benjamin W. Teh
    • 1
    • 2
    • 3
    Email author
  • Christine Brown
    • 1
  • Trish Joyce
    • 1
    • 4
  • Leon J. Worth
    • 1
    • 2
    • 3
    • 5
  • Monica A. Slavin
    • 1
    • 2
    • 3
    • 5
  • Karin A. Thursky
    • 1
    • 2
    • 3
    • 5
  1. 1.Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneAustralia
  2. 2.Sir Peter MacCallum Department of OncologyPeter MacCallum Cancer CentreParkvilleAustralia
  3. 3.National Centre for Infections in CancerParkvilleAustralia
  4. 4.Department of HaematologyPeter MacCallum Cancer CentreParkvilleAustralia
  5. 5.Department of MedicineUniversity of MelbourneParkvilleAustralia

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