Time to clinical response: An outcome of antibiotic therapy of febrile neutropenia with implications for quality and cost of care

Purpose: To determine whether antibiotic regimens with similar rates of res ponse differ significantly in the speed of response and to estimate the imp act of this difference on the cost of febrile neutropenia. Methods: The time point of clinical response wets defined by comparing the sensitivity, specificity, and predictive values of alternative objective an d subjective definitions, Data from 488 episodes of febrile neutropenia, tr eated with either of two commonly used antibiotics (coded A or 8) during si x clinical trials, were pooled to compare the median time to clinical respo nse, days of antibiotic therapy and hospitalization, and estimated costs. Results: Response rates were similar; however, the median time to clinical response was significantly shorter with A-based regimens (5 days) compared with B-based regimens (7 days; P = .003). After 72 hours of therapy, 33% of patients who received A but only 18% of those who received B had responded (P = .01). These differences resulted in fewer days of antibiotic therapy and hospitalization with A-based regimens (7 and 9 days) compared with B-ba sed regimens (9 and 12 days, respectively; P < .04) and in significantly lo wer estimated median casts ($8,491 v $11,133 per episode; P = .03), Early d ischarge at the time of clinical response should reduce the median cost fro m $10,752 to $8,162 (P < .001). Conclusion: Despite virtually identical Kites of response, time to clinical response and estimated cost of care varied significantly among regimens. A n early discharge strategy based on our definition of the time point of cli nical response may further reduce the cost of treating non-low-risk patient s with febrile neutropenia, (C) 2000 by American Society of Clinical Oncolo gy.