儿童癌症患者的发热性中性粒细胞减少症（FN）通常需要住院治疗，但低风险患者可能在门诊进行有效管理，从而可能降低整体医疗费用。关于FN护理费用的更新数据尚缺乏。本研究从医疗系统角度进行了基于底层成本的微观成本分析，使用了在澳大利亚“PICNICC”(癌症患儿中性粒细胞减少症感染并发症预测)研究期间收集的数据。住院费用来自医院行政记录，门诊费用来自医疗保险数据。根据“PICNICC”标准，费用按风险级别（低/高风险）分层。通过自助重抽样和使用线性模型，获得了估计的平均费用，以考虑个体之间的多次事件和可能影响费用的其他临床因素。FN护理的总费用对于被归类为高风险的FN事件（17,827美元，95%置信区间[CI]: 17,193美元-18,461美元）明显高于低风险（10,574美元，95%CI: 9,818美元-11,330美元）。尽管在费用结构、日均费用和资源使用模式上没有差异，住院费用对于高风险事件明显高于低风险事件。住院时间是与护理总费用显著相关的唯一可改变的因素。除抗肿瘤药物外，抗微生物药物是整个分析期内住院和门诊治疗中最常用的药物。FN的费用受住院入院和住院时间的驱动。这表明门诊管理低风险患者有可能降低在FN事件治疗过程中的住院费用。进一步的研究将确定将费用转移到门诊环境是否在整体上具有成本效益。© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.

Febrile neutropenia (FN) in children with cancer generally requires in-hospital care, but low-risk patients may be successfully managed in an outpatient setting, potentially reducing the overall healthcare costs. Updated data on the costs of FN care are lacking.A bottom-up microcosting analysis was conducted from the healthcare system perspective using data collected alongside the Australian PICNICC (Predicting Infectious Complications of Neutropenic sepsis In Children with Cancer) study. Inpatient costs were accessed from hospital administrative records and outpatient costs from Medicare data. Costs were stratified by risk status (low/high risk) according to the PICNICC criteria. Estimated mean costs were obtained through bootstrapping and using a linear model to account for multiple events across individuals and other clinical factors that may impact costs.The total costs of FN care were significantly higher for FN events classified as high-risk ($17,827, 95% confidence interval [CI]: $17,193-$18,461) compared to low-risk ($10,574, 95% CI: $9818-$11,330). In-hospital costs were significantly higher for high-risk compared to low-risk events, despite no differences in the cost structure, mean cost per day, and pattern of resource use. Hospital length of stay (LOS) was the only modifiable factor significantly associated with total costs of care. Excluding antineoplastics, antimicrobials are the most commonly used medications in the inpatient and outpatient setting for the overall period of analysis.The FN costs are driven by in-hospital admission and LOS. This suggests that the outpatient management of low-risk patients is likely to reduce the in-hospital cost of treating an FN event. Further research will determine if shifting the cost to the outpatient setting remains cost-effective overall.© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.