Economic Impact with Home Delivery of Chemotherapy to Pediatric Oncology Patients

Author:

Holdsworth Mark T1,Raisch Dennis W2,Chavez Cathy M3,Duncan Marilyn H4,Parasuraman Tv5,Cox Fred M6

Affiliation:

1. College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, NM

2. Veterans Affairs Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, and College of Pharmacy, University of New Mexico Health Sciences Center

3. Division of Pediatric Oncology, Department of Pediatrics, University of New Mexico Health Sciences Center

4. Division of Pediatric Oncology, Department of Pediatrics, University of New Mexico Health Sciences Center, and School of Medicine, University of New Mexico, Albuquerque, NM

5. Medical Affairs, Glaxo Research Institute, Research Triangle Park, NC

6. Medical Affairs, Glaxo Research Institute

Abstract

Objective To examine the economic impact of a home chemotherapy program (HCP) for pediatric oncology patients. Rationale Factors that led to initiation of an HCP included availability of specially trained nurses and programmable ambulatory infusion devices at local home care agencies, routine central venous catheter placement, inpatient bed space shortages, and the availability of ondansetron. Setting Chemotherapy delivery in the home setting from June 1991 through June 1994. Design Charge data and nausea and vomiting severity data were collected for patients treated through the HCP. Methods Economic impact was calculated by incorporating and summing all charge categories associated with hospital admission for chemotherapy (HAC) versus delivery by the HCP. All data were adjusted for 1993 dollars, and reflect charges for the average patient size (1 m2). Charge data for each chemotherapy protocol delivered in the home were analyzed by calculating the differences between HAC and HCP charges using the following formula: charge difference (HAC - HCP) per protocol times the number of courses. Total economic impact was calculated by summing the differences in charges for each protocol. Results A total of 262 chemotherapy courses were given to 44 patients (mean age 9.5 ± 5.1 y) through the HCP, which represented 1012 patient care days and 24 different chemotherapy protocols. Monetary savings from the HCP ranged from $5180 per course of ifosfamide plus etoposide to $367 per course for high-dose methotrexate. Total monetary savings from the HCP during the 3-year period was $640 793. Successful control of nausea and vomiting with a combination of ondansetron plus methylprednisolone was achieved in approximately 80% of the patients receiving highly emetogenic chemotherapy protocols. Conclusions HCP for pediatric oncology patients results in substantial monetary savings to payors. Effective control of nausea and vomiting can be accomplished at home in the majority of patients with an ondansetron-based antiemetic regimen.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

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