Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre
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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.
KeywordsLow 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.
- 3.Pettengell R, Schwenkglenks M, Leonard R, Bosly A, Paridaens R, Constenla M, Szucs TD, Jackisch C, Impact of Neutropenia in Chemotherapy-European Study G (2008) Neutropenia occurrence and predictors of reduced chemotherapy delivery: results from the INC-EU prospective observational European neutropenia study. Support Care Cancer 16:1299–1309CrossRefPubMedGoogle Scholar
- 4.Penack O, Buchheidt D, Christopeit M, von Lilienfeld-Toal M, Massenkeil G, Hentrich M, Salwender H, Wolf HH, Ostermann H, German Society of H, Oncology (2011) Management of sepsis in neutropenic patients: guidelines from the infectious diseases working party of the German Society of Hematology and Oncology. Ann Oncol 22:1019–1029CrossRefPubMedGoogle Scholar
- 5.Penack O, Becker C, Buchheidt D, Christopeit M, Kiehl M, von Lilienfeld-Toal M, Hentrich M, Reinwald M, Salwender H, Schalk E, Schmidt-Hieber M, Weber T, Ostermann H (2014) Management of sepsis in neutropenic patients: 2014 updated guidelines from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO). Ann Hematol 93:1083–1095CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol Off J Am Soc Clin Oncol 18:3038–3051CrossRefGoogle Scholar
- 8.Lingaratnam S, Slavin MA, Mileshkin L, Solomon B, Burbury K, Seymour JF, Sharma R, Koczwara B, Kirsa SW, Davis ID, Prince M, Szer J, Underhill C, Morrissey O, Thursky KA (2011) An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009. Intern Med J 41:110–120CrossRefPubMedGoogle Scholar
- 10.Worth LJ, Lingaratnam S, Taylor A, Hayward AM, Morrissey S, Cooney J, Bastick PA, Eek RW, Wei A, Thursky KA, Australian Consensus Guidelines Steering C (2011) Use of risk stratification to guide ambulatory management of neutropenic fever. Australian Consensus Guidelines 2011 Steering Committee. Intern Med J 41:82–89CrossRefPubMedGoogle Scholar
- 11.Lingaratnam S, Worth LJ, Slavin MA, Bennett CA, Kirsa SW, Seymour JF, Dalton A, Koczwara B, Prince HM, O'Reilly M, Mileshkin L, Szer J, Thursky KA (2011) A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment. Aust Health Rev 35:491–500PubMedGoogle Scholar
- 12.Lingaratnam S, Mellerick A, Worth LJ, Green M, Guy S, Kirsa S, Slavin M, Renwick W, Filshie R, Thursky KA (2013) Feasibility of early discharge strategies for neutropenic fever: outcomes of a Victorian organisational readiness assessment and pilot. Intern Med J 43:979–986CrossRefPubMedGoogle Scholar
- 13.Australian Institute of Health and Welfare (2012) Cancer incidence projections: Australia 2011 to 2020. Australian Institute of Health and Welfare, CanberraGoogle Scholar
- 14.Cancer Council Victoria (2012) Cancer Services. Cancer Council Victoria. Australian Institute of Health and Welfare, MelbourneGoogle Scholar