ECONOMIC-IMPACT WITH HOME DELIVERY OF CHEMOTHERAPY TO PEDIATRIC ONCOLOGY PATIENTS

OBJECTIVE: To examine the economic impact of a home chemotherapy progr am (HCP) for pediatric oncology patients. RATIONALE: Factors that led to initiation of an HCP included availability of specially trained nur ses and programmable ambulatory infusion devices at local home care ag encies, 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 calcul ated by incorporating and summing all charge categories associated wit h 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 m(2)). Charge data for each chemotherapy prot ocol delivered in the home were analyzed by calculating the difference s between HAC and HCP charges using the following formula: charge diff erence (HAC - HCP) per protocol times the number of courses. Total eco nomic 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 repres ented 1012 patient care days and 24 different chemotherapy protocols. Monetary savings from the HCP ranged from $5180 per course of ifosfami de 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 ondans etron plus methylprednisolone was achieved in approximately 80% of the patients receiving highly emetogenic chemotherapy protocols. CONCLUSI ONS: HCP for pediatric oncology patients results in substantial moneta ry savings to payers. Effective control of nausea and vomiting can be accomplished at home in the majority of patients with an ondansetron-b ased antiemetic regimen.