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Çocukluk çağı febril nötropenisinde solunum virüsü panelinin maliyet etkinliği

Year 2023, Volume: 13 Issue: 2, 342 - 346, 22.03.2023
https://doi.org/10.16899/jcm.1228131

Abstract

Amaç: Bu çalışmanın amacı, kemoterapi alan çocuklarda febril nötropeni (FN) atağında respiratuar virüs panel testinin klinik faydasını ve maliyetini analiz etmektir.
Gereç ve Yöntem: 2014-2018 yılları arasında kanserli 93 çocukta 180 FN epizodu retrospektif olarak analiz edildi. Hastalar solunum virüsü paneli olanlar (Grup A) ve olmayanlar (Grup B) olarak ikiye ayrıldı. Grup A ve B’nin demografik ve klinik özellikleri ile maliyet analizleri not edildi.
Bulgular: Febril nötropeni ataklarının 46'sı Grup A'da (%25,5) ve 134'ü Grup B'de (%74,5) idi. Grup A’da yer alan 46 epizodun 45’inde (%97,8) pozitifilik saptadık. Grup A'da 14 FN atağında (%30,4) modifikasyon gerekirken, B grubunda 35 FN atağında (%26,1) modifikasyon gerekti. Aradaki fark istatistiksel olarak anlamlı değildi (p=0,570). Grup A'daki 46 FN atağından sadece 5’inde (%10,8) solunum virüsü paneline göre modifiye edildi. Solunum virüsü paneli fiyatları 72,43$ (çeyrekler arası aralık, 38,8). Medyan solunum virüsü paneli maliyetinin toplam maliyete oranı %9,67'dir (çeyrekler arası aralık 11,6). Grup A'nın medyan toplam maliyeti 663,18$ (çeyrekler arası aralık, 850,1), B grubunun maliyeti ise 596,24$ (çeyrekler arası aralık, 723,81). Fark istatistiksel olarak anlamlı değildi (p=0.141).
Sonuç: Solunum yolu paneli FN ataklarında hızlı sonuç vererek antibiyotik tercihine katkı sağlayabilir. Bununla birlikte, modifikasyon oranları üzerinde herhangi bir etki gözlenmedi ve hastaların sadece küçük bir yüzdesine solunum yolu paneline göre antibiyotik modifikasyonu uygulandı.

Supporting Institution

Yok

Project Number

Yok

References

  • 1. Lehrnbecher T. Treatment of fever in neutropenia in pediatric oncology patients. Curr Opin Pediatr. 2019;31(1):35-40.
  • 2. Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 Update. J Clin Oncol. 2017;35(18):2082-2094.
  • 3. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93.
  • 4. Düzova A, Kutluk T, Kanra G, et al. Monotherapy with meropenem versus combination therapy with piperacillin plus amikacin as empiric therapy for neutropenic fever in children with lymphoma and solid tumors. Turk J Pediatr. 2001;43(2):105-9.
  • 5. Kutluk T, Kurne O, Akyüz C, et al. Cefepime vs. Meropenem as empirical therapy for neutropenic fever in children with lymphoma and solid tumours. Pediatr Blood Cancer. 2004;42(3):284-6.
  • 6. Secmeer G, Devrim I, Kara A, et al. Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol. 2007;29(2):107-11.
  • 7. Demir HA, Kutluk T, Ceyhan M, et al. Comparison of sulbactam-cefoperazone with carbapenems as empirical monotherapy for febrile neutropenic children with lymphoma and solid tumors. Pediatr Hematol Oncol. 2011;28(4):299-310.
  • 8. Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2009;31(9):623-9.
  • 9. Cerdeira Barreiro N, Santiago-García B, et al. Detection of respiratory viruses in the clinical outcome of children with fever and neutropenia. Pediatr Infect Dis J. 2020;39(6):533-538.
  • 10. Ramphal R, Grant RM, Dzolganovski B, et al. Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study. Pediatr Infect Dis J. 2007;26(8):700-4.
  • 11. Katsimpardi K, Papadakis V, Pangalis A, et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment. Support Care Cancer. 2006;14(3):277-84.
  • 12. Lindblom A, Bhadri V, Söderhäll S, et al. Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol. 2010;47(3):234-7.
  • 13. Torres JP, Labraña Y, Ibañez C, et al. Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia. Pediatr Infect Dis J. 2012;31(9):889-93.
  • 14. Suryadevara M, Tabarani CM, Bartholoma N, et al. Nasopharyngeal detection of respiratory viruses in febrile neutropenic children. Clin Pediatr (Phila). 2012;51(12):1164-7.
  • 15. Torres JP, De la Maza V, Kors L, et al. Respiratory viral infections and coinfections in children with cancer, fever and neutropenia: clinical outcome of infections caused by different respiratory viruses. Pediatr Infect Dis J. 2016;35(9):949-54.
  • 16. Cerdeira Barreiro N, Santiago-García B, Casas I, et al. Detection of respiratory viruses in the clinical outcome of children with fever and neutropenia. Pediatr Infect Dis J. 2020;39(6):533-538.
  • 17. Aydin Köker S, Demirağ B, Tahta N, et al. A 3-Year retrospective study of the epidemiology of acute respiratory viral infections in pediatric patients with cancer undergoing chemotherapy. J Pediatr Hematol Oncol. 2019;41(4):e242-e246.
  • 18. Büyükkapu-Bay S, Kebudi R, Görgün Ö, Meşe S, Zülfikar B, Badur S. Respiratory viral infection`s frequency and clinical outcome in symptomatic children with cancer: A single center experience from a middle-income country. Turk J Pediatr. 2018;60(6):653-659.
  • 19. Meena JP, Brijwal M, Seth R, et al. Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia. Pediatr Hematol Oncol. 2019;36(6):330-343.
  • 20. Agrawal AK, Feusner J. Supportive care of patients with cancer. In: Fish JD, Lipton JM, Lanzkowsky P, editors, Lanzkowsky’s Manual of Pediatric Hematology and Oncology. San Diego: Academic Press; 2022. p. 675-711.
  • 21. Shinn K, Wetzel M, DeGroote NP, et al. Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia. Pediatr Blood Cancer. 2020;67(11):e28570.
  • 22. Bay SB, Kebudi R. Respiratory viral panel testing in children with cancer and respiratory tract infections. Pediatr Blood Cancer. 2021;68(3):e28773.

The cost effectiveness of the respiratory virus panel in childhood febrile neutropenia

Year 2023, Volume: 13 Issue: 2, 342 - 346, 22.03.2023
https://doi.org/10.16899/jcm.1228131

Abstract

ABSTRACT
Objective: The aim of this study is to analyze the clinical utility and cost of the respiratory virus panel test in the febrile neutropenia (FN) episode in children undergoing chemotherapy.
Material and Method: From 2014 to 2018, 180 episodes of FN in 93 children with cancer were retrospectively analyzed. The patients were divided into those with (Group A) and without respiratory virus panel (Group B). The demographic and clinical features and cost analysis of the groups A and B were noted.
Results: Of these FN episodes, 46 were in Group A (25.5%) and 134 were in Group B (74.5%). We found positivity in 45 (97.8%) of 46 episodes in Group A. While modification was required in 14 FN episodes (30.4%) in Group A, modification was required in 35 FN episodes (26.1%) in group B. The difference was not statistically significant (p=0.570). In Group A, only 5 (10.8%) were modified according to the respiratory virus panel. The respiratory virus panel prices were $72.43 (interquartile range, $38.8). The ratio of respiratory virus panel cost to the total cost was 9.67% (interquartile range 11.6). The median total cost of group A was $663.18 (interquartile range, 850.1), while that of group B was $596.24 (interquartile range, 723.81). The difference was not statistically significant (p=0.141).
Conclusion: The respiratory virus panel may contribute to the preference of antibiotics by giving rapid results in FN attacks. However, no effect on modification rates was observed, and only a small percentage of patients underwent antibiotic modification according to respiratory virus panel.

Project Number

Yok

References

  • 1. Lehrnbecher T. Treatment of fever in neutropenia in pediatric oncology patients. Curr Opin Pediatr. 2019;31(1):35-40.
  • 2. Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 Update. J Clin Oncol. 2017;35(18):2082-2094.
  • 3. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-93.
  • 4. Düzova A, Kutluk T, Kanra G, et al. Monotherapy with meropenem versus combination therapy with piperacillin plus amikacin as empiric therapy for neutropenic fever in children with lymphoma and solid tumors. Turk J Pediatr. 2001;43(2):105-9.
  • 5. Kutluk T, Kurne O, Akyüz C, et al. Cefepime vs. Meropenem as empirical therapy for neutropenic fever in children with lymphoma and solid tumours. Pediatr Blood Cancer. 2004;42(3):284-6.
  • 6. Secmeer G, Devrim I, Kara A, et al. Role of procalcitonin and CRP in differentiating a stable from a deteriorating clinical course in pediatric febrile neutropenia. J Pediatr Hematol Oncol. 2007;29(2):107-11.
  • 7. Demir HA, Kutluk T, Ceyhan M, et al. Comparison of sulbactam-cefoperazone with carbapenems as empirical monotherapy for febrile neutropenic children with lymphoma and solid tumors. Pediatr Hematol Oncol. 2011;28(4):299-310.
  • 8. Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol. 2009;31(9):623-9.
  • 9. Cerdeira Barreiro N, Santiago-García B, et al. Detection of respiratory viruses in the clinical outcome of children with fever and neutropenia. Pediatr Infect Dis J. 2020;39(6):533-538.
  • 10. Ramphal R, Grant RM, Dzolganovski B, et al. Herpes simplex virus in febrile neutropenic children undergoing chemotherapy for cancer: a prospective cohort study. Pediatr Infect Dis J. 2007;26(8):700-4.
  • 11. Katsimpardi K, Papadakis V, Pangalis A, et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment. Support Care Cancer. 2006;14(3):277-84.
  • 12. Lindblom A, Bhadri V, Söderhäll S, et al. Respiratory viruses, a common microbiological finding in neutropenic children with fever. J Clin Virol. 2010;47(3):234-7.
  • 13. Torres JP, Labraña Y, Ibañez C, et al. Frequency and clinical outcome of respiratory viral infections and mixed viral-bacterial infections in children with cancer, fever and neutropenia. Pediatr Infect Dis J. 2012;31(9):889-93.
  • 14. Suryadevara M, Tabarani CM, Bartholoma N, et al. Nasopharyngeal detection of respiratory viruses in febrile neutropenic children. Clin Pediatr (Phila). 2012;51(12):1164-7.
  • 15. Torres JP, De la Maza V, Kors L, et al. Respiratory viral infections and coinfections in children with cancer, fever and neutropenia: clinical outcome of infections caused by different respiratory viruses. Pediatr Infect Dis J. 2016;35(9):949-54.
  • 16. Cerdeira Barreiro N, Santiago-García B, Casas I, et al. Detection of respiratory viruses in the clinical outcome of children with fever and neutropenia. Pediatr Infect Dis J. 2020;39(6):533-538.
  • 17. Aydin Köker S, Demirağ B, Tahta N, et al. A 3-Year retrospective study of the epidemiology of acute respiratory viral infections in pediatric patients with cancer undergoing chemotherapy. J Pediatr Hematol Oncol. 2019;41(4):e242-e246.
  • 18. Büyükkapu-Bay S, Kebudi R, Görgün Ö, Meşe S, Zülfikar B, Badur S. Respiratory viral infection`s frequency and clinical outcome in symptomatic children with cancer: A single center experience from a middle-income country. Turk J Pediatr. 2018;60(6):653-659.
  • 19. Meena JP, Brijwal M, Seth R, et al. Prevalence and clinical outcome of respiratory viral infections among children with cancer and febrile neutropenia. Pediatr Hematol Oncol. 2019;36(6):330-343.
  • 20. Agrawal AK, Feusner J. Supportive care of patients with cancer. In: Fish JD, Lipton JM, Lanzkowsky P, editors, Lanzkowsky’s Manual of Pediatric Hematology and Oncology. San Diego: Academic Press; 2022. p. 675-711.
  • 21. Shinn K, Wetzel M, DeGroote NP, et al. Impact of respiratory viral panel testing on length of stay in pediatric cancer patients admitted with fever and neutropenia. Pediatr Blood Cancer. 2020;67(11):e28570.
  • 22. Bay SB, Kebudi R. Respiratory viral panel testing in children with cancer and respiratory tract infections. Pediatr Blood Cancer. 2021;68(3):e28773.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Buket Kara 0000-0003-4737-1901

Gülsüm Alkan 0000-0003-3384-769X

Kübra Ertan 0000-0002-9981-8413

Melike Emiroğlu 0000-0003-1307-0246

Prof. Dr. Uğur Arslan 0000-0001-6974-9173

Hüsamettin Vatansev 0000-0002-0230-3414

Yavuz Köksal 0000-0002-9190-7817

Project Number Yok
Early Pub Date January 23, 2023
Publication Date March 22, 2023
Acceptance Date February 10, 2023
Published in Issue Year 2023 Volume: 13 Issue: 2

Cite

AMA Kara B, Alkan G, Ertan K, Emiroğlu M, Arslan PDU, Vatansev H, Köksal Y. The cost effectiveness of the respiratory virus panel in childhood febrile neutropenia. J Contemp Med. March 2023;13(2):342-346. doi:10.16899/jcm.1228131