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Time to Clinical Response: An Outcome of Antibiotic Therapy of Febrile Neutropenia With Implications for Quality and Cost of Care

From the The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Linda Elting, DrPH, Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 40, Houston, TX 77030; email lelting{at}mdanderson.org

PURPOSE: To determine whether antibiotic regimens with similar rates of response differ significantly in the speed of response and to estimate the impact of this difference on the cost of febrile neutropenia.

METHODS: The time point of clinical response was defined by comparing the sensitivity, specificity, and predictive values of alternative objective and subjective definitions. Data from 488 episodes of febrile neutropenia, treated with either of two commonly used antibiotics (coded A or B) during six clinical trials, were pooled to compare the median time to clinical response, 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-based regimens (9 and 12 days, respectively; P < .04) and in significantly lower estimated median costs ($8,491 v $11,133 per episode; P = .03). Early discharge at the time of clinical response should reduce the median cost from $10,752 to $8,162 (P < .001).

CONCLUSION: Despite virtually identical rates of response, time to clinical response and estimated cost of care varied significantly among regimens. An early discharge strategy based on our definition of the time point of clinical response may further reduce the cost of treating non–low-risk patients with febrile neutropenia.

Presented in part at the Second International Febrile Neutropenia Meeting, Brussels, Belgium, December 14-16, 1995, and the Annual Meeting of the Multinational Association for Supportive Care in Cancer, St Galen, Switzerland, February 26 through March 1, 1997.

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