Assessing the Economic Implications of Step-Down Outpatient Management for Fever and Neutropenia Episodes in Pediatric Cancer Patients: A Cost Minimization Analysis

Abstract Background The management of febrile neutropenia (FN) in pediatric cancer patients has traditionally been conducted in a hospital setting. However, recent evidence has indicated that outpatient management of FN can be equally effective compared to inpatient care. Based on this evidence, we conducted a cost-minimization analysis (CMA) specifically focused on pediatric cancer patients in Mexico Methods The CMA was performed from a societal perspective using patient-level data derived from a previous noninferiority clinical trial that compared outpatient treatment to inpatient treatment for FN in children with cancer. Direct and indirect costs were collected prospectively. The costs were adjusted for inflation and converted to US dollars, with values standardized to August 2022 costs. Statistical analysis using bootstrap methods was employed to obtain robust estimations for decision-making within the Mexican public health care system. Results A total of 117 FN episodes were analyzed, with 60 in the outpatient group and 57 in the inpatient group; however, complete cost data were available for only 115 FN episodes. The analysis revealed an average savings of $1,087 per FN event managed on an outpatient basis, representing a significant reduction of 92% compared to inpatient treatment. Length of hospital stay and inpatient consultations emerged as the primary cost drivers within the inpatient care group Conclusion This CMA demonstrates that the step-down outpatient management approach is not only cost-effective but also cost-saving when compared to inpatient management of FN in pediatric cancer patients. The mean difference observed between the treatment groups provides support for decision-making within the public health care system, as outpatient management of FN allows for substantial cost savings without compromising patient health.