Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt
PURPOSEFebrile neutropenia (FN) is a common cancer complication in children. A growing body of evidence suggests that home-based care with oral antibiotics is safe and effective in carefully selected children with low-risk (LR) FN. This study aimed to assess the efficacy and safety of oral levofloxa...
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2025-04-01
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| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.24.00182 |
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| author | Reham Abdelaziz Khedr Ebtehal Ali Zeinab Ahmad Elshafei Hadir Ahmed El-Mahallawy Nashwa Ezz Eldeen |
| author_facet | Reham Abdelaziz Khedr Ebtehal Ali Zeinab Ahmad Elshafei Hadir Ahmed El-Mahallawy Nashwa Ezz Eldeen |
| author_sort | Reham Abdelaziz Khedr |
| collection | DOAJ |
| description | PURPOSEFebrile neutropenia (FN) is a common cancer complication in children. A growing body of evidence suggests that home-based care with oral antibiotics is safe and effective in carefully selected children with low-risk (LR) FN. This study aimed to assess the efficacy and safety of oral levofloxacin versus oral amoxicillin-clavulanate/ciprofloxacin in the management of LR-FN in children with cancer over a time horizon of 7 days from the National Cancer Institute (NCI) perspective.PATIENTS AND METHODSThis is a randomized controlled study conducted at the NCI from December 2021 to September 2022, including children and adolescents age between 3 and 18 years who presented to the emergency room with LR-FN criteria with the exclusion of patients younger than 3 years and patients with Down syndrome. One hundred LR-FN episodes were enrolled in each arm. Patient demographics, microbiologic data, and outcomes were collected at different time points. A decision analytic model was created to compare the two treatment strategies. The outcome measures included quality-adjusted FN episodes, costs, and incremental cost-effectiveness ratios.RESULTSLevofloxacin was a safe and effective treatment option for LR-FN. It proved to be the dominant strategy against amoxicillin-clavulanate/ciprofloxacin with an incremental quality-adjusted life-year (QALY) of 0.0001 and a lower cost of 62.4996 Egyptian pounds (EGPs) in the treatment of home-based LR-FN with a willingness to pay a threshold of 77,520 EGPs per QALY (1 gross domestic product/capita).CONCLUSIONFor the treatment of FN in pediatric patients with cancer, levofloxacin offers a cost-saving option with improved survival benefits over a 7-day time horizon from the NCI perspective. These findings will help health care decisions regarding the allocation of health care system resources to improve supportive care for patients with LR-FN. |
| format | Article |
| id | doaj-art-2bba45a24b644095bea4bca425373bc5 |
| institution | DOAJ |
| issn | 2687-8941 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj-art-2bba45a24b644095bea4bca425373bc52025-08-20T03:15:03ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412025-04-011110.1200/GO.24.00182Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in EgyptReham Abdelaziz Khedr0Ebtehal Ali1Zeinab Ahmad Elshafei2Hadir Ahmed El-Mahallawy3Nashwa Ezz Eldeen4Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, EgyptPediatric Oncology, National Cancer Institute, Cairo University, Cairo, EgyptPharmacoeconomic Unit, Egyptian Drug Authority (EDA), Cairo, EgyptClinical Pathology, National Cancer Institute, Cairo University, Cairo, EgyptPediatric Oncology, National Cancer Institute, Cairo University, Cairo, EgyptPURPOSEFebrile neutropenia (FN) is a common cancer complication in children. A growing body of evidence suggests that home-based care with oral antibiotics is safe and effective in carefully selected children with low-risk (LR) FN. This study aimed to assess the efficacy and safety of oral levofloxacin versus oral amoxicillin-clavulanate/ciprofloxacin in the management of LR-FN in children with cancer over a time horizon of 7 days from the National Cancer Institute (NCI) perspective.PATIENTS AND METHODSThis is a randomized controlled study conducted at the NCI from December 2021 to September 2022, including children and adolescents age between 3 and 18 years who presented to the emergency room with LR-FN criteria with the exclusion of patients younger than 3 years and patients with Down syndrome. One hundred LR-FN episodes were enrolled in each arm. Patient demographics, microbiologic data, and outcomes were collected at different time points. A decision analytic model was created to compare the two treatment strategies. The outcome measures included quality-adjusted FN episodes, costs, and incremental cost-effectiveness ratios.RESULTSLevofloxacin was a safe and effective treatment option for LR-FN. It proved to be the dominant strategy against amoxicillin-clavulanate/ciprofloxacin with an incremental quality-adjusted life-year (QALY) of 0.0001 and a lower cost of 62.4996 Egyptian pounds (EGPs) in the treatment of home-based LR-FN with a willingness to pay a threshold of 77,520 EGPs per QALY (1 gross domestic product/capita).CONCLUSIONFor the treatment of FN in pediatric patients with cancer, levofloxacin offers a cost-saving option with improved survival benefits over a 7-day time horizon from the NCI perspective. These findings will help health care decisions regarding the allocation of health care system resources to improve supportive care for patients with LR-FN.https://ascopubs.org/doi/10.1200/GO.24.00182 |
| spellingShingle | Reham Abdelaziz Khedr Ebtehal Ali Zeinab Ahmad Elshafei Hadir Ahmed El-Mahallawy Nashwa Ezz Eldeen Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt JCO Global Oncology |
| title | Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt |
| title_full | Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt |
| title_fullStr | Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt |
| title_full_unstemmed | Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt |
| title_short | Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt |
| title_sort | cost effectiveness of oral levofloxacin versus amoxicillin clavulanate ciprofloxacin for outpatient management of low risk febrile neutropenia in children with cancer in egypt |
| url | https://ascopubs.org/doi/10.1200/GO.24.00182 |
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