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Comparing costs of home- versus hospital-based treatment of infections in adults in a specialist cystic fibrosis center

Published online by Cambridge University Press:  25 October 2005

Rachel A. Elliott ,
Judith Thornton ,
A. Kevin Webb ,
Mary Dodd  and
Mary P. Tully
Rachel A. Elliott
Affiliation:
University of Manchester
Judith Thornton
Affiliation:
University of Manchester
A. Kevin Webb
Affiliation:
Wythenshawe Hospital
Mary Dodd
Affiliation:
Wythenshawe Hospital
Mary P. Tully
Affiliation:
University of Manchester
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Abstract

Objectives: This study aimed to produce valid patient-based UK National Health Service (NHS) costs for adults with cystic fibrosis to identify differences between hospital- and home-based treatments for infections.

Methods: A costing study was carried out in adults with cystic fibrosis (CF) in the United Kingdom, who required intravenous antibiotic treatments for respiratory infections, administered either at home or in the hospital. The perspective was that of the NHS hospital trust. Data were collected retrospectively for each patient for 1 year using clinical records. Data were collected for 116 adults with CF between 2000 and 2001, when 42,382 treatment days (454 courses) of intravenous antibiotics were administered; 213 courses with intention-to-treat at home and 241 courses with intention-to-treat in the hospital. The mean length of a course was 15.3 days.

Results: Patients who had >60 percent of courses at home over 1 year had a mean cost of £13,528, compared with £22,609 for patients who had >60 percent of courses in the hospital, and a mean cost of £19,927 for patients who had an equal mix of home and hospital care (p = .0001).

Conclusions: The key cost-generating events in CF respiratory infections are hospital admissions. Future studies assessing costs should concentrate on factors affecting admissions, length of stay, staff input, and alternative methods of home-care provision, rather than marginal effects, such as using different antibiotics.

Keywords

Economic evaluationCystic fibrosisAntibiotic treatmentCosting methodology
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 4 , October 2005 , pp. 506 - 510
Copyright
© 2005 Cambridge University Press

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References

Barber JA, Thompson S. 2000 Analysis of cost data in randomized trials: An application of the non-parametric bootstrap. Stat Med. 19: 3219– 3236.Google Scholar
Bosso JA, Huckendubler Stephenson SE, Herbst JJ. 1985 Feasibility and cost savings of aminoglycosides in outpatients with cystic fibrosis. Drug Int Clin Pharm. 19: 52– 54.Google Scholar
Bosworth DG, Nielson DW. 1997 Effectiveness of home versus hospital care in the routine treatment of cystic fibrosis. Pediatr Pulmonol. 24: 42– 47.Google Scholar
Bradley J, Wallace E, Elborn J, Howard J, McCoy M. 1999 An audit of the effect of intravenous antibiotic treatment on pirometric measures of pulmonary function in cystic fibrosis. Ir J Med Sci. 168: 25– 28.Google Scholar
Bramwell EC, Halpin DM, Duncan-Skingle F, Hodson M, Geddes DM. 1995 Home treatment of patients with cystic fibrosis using the ‘Intermate’: The first year's experience. J Adv Nurs. 22: 1063– 1067.Google Scholar
Briggs A, Gray A. 1998 The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 3: 233– 245.Google Scholar
British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary; 2001.
Donati MA, Guenette G, Auerbach H. 1987 Prospective controlled study of home and hospital therapy of cystic fibrosis pulmonary disease. J Pediatr. 111: 28– 33.Google Scholar
Dyer J, Wedlock K, Law A, Langton Hewer S. 2000 Cost comparisons of domiciliary intravenous antibiotics with hospital intravenous antibiotics. Pediatr Pulmonol. (Suppl)20: A577.Google Scholar
Elphick HE, Tan A. Single versus combination intravenous antibiotic treatment for people with cystic fibrosis Cochrane Database Syst Rev. 2005; 18: CD002007.Google Scholar
Elphick HE, Tan A, Ashby D, Smyth RL. 2002 Systematic reviews and lifelong diseases. BMJ. 325: 381– 384.Google Scholar
Geddes D. Cystic fibrosis: Epidemiology and pathogenesis. In: Brewis R, Corrin B, Geddes D, Gibson G, eds. Respiratory medicine. 2nd ed. London: WB Saunders Company Ltd; 1995: 1317– 1329.
Gilbert J, Robinson T, Littlewood J. 1988 Home intravenous antibiotic treatment in cystic fibrosis. Arch Dis Child. 63: 512– 517.Google Scholar
Kane RE, Jennison K, Wood C, Black PG, Herbst JJ. 1988 Cost savings and economic considerations using home intravenous antibiotic therapy for cystic fibrosis patients. Pediatr Pulmonol. 4: 84– 89.Google Scholar
Krauth C, Jalilvand N, Wlete T, Busse R. 2003 Cystic fibrosis: Cost of illness and considerations for the economic evaluation of potential therapies. Pharmacoeconomics. 21: 1001– 1024.Google Scholar
Loader J, Sewell G. 1998 The current position in England concerning home-based ambulatory infusion provided under EL(95)5. Pharm J. 261: R42.Google Scholar
Marco T, Asensio O, Bosque M, de Gracia J, Serra C. 2000: Home intravenous antibiotics for cystic fibrosis Cochrane Database Syst Rev. CD001917.Google Scholar
Office of Health Economics. OHE Compendium of Health Statistics. 2001 13th ed.
Pond M, Newport M, Joanes D, Conway S. 1994 Home versus hospital intravenous antibiotic therapy in the treatment of young adults with cystic fibrosis. Eur Respir J. 7: 1640– 1644.Google Scholar
Robson M, Abbott J, Webb K, Dodd M, Walsworth-Bell J. 1992 A cost description of an adult cystic fibrosis unit and cost analyses of different categories of patients. Thorax. 47: 684– 689.Google Scholar
Thornton J, Elliott RA, Tully M, Webb K, Dodd M. 2004 Long-term clinical outcome of home and hospital intravenous antibiotic treatment in adults with cystic fibrosis. Thorax. 59: 242– 246.Google Scholar
Torgerson DJ, Sibbald B. 1998; What is a patient preference trial? BMJ. 316: 360.Google Scholar