Transition of dose-adjusted EPOCH therapy into the outpatient healthcare setting, quality and cost considerations

Abstract

Specific Aims: To determine if outpatient administration of DA-EPOCH +/- R chemotherapy is associated with increased efficacy, cost effectiveness, or increased patient risk for developing adverse events when compared with inpatient administration of the same regimen. Subjects: Adults receiving EPOCH-based regimens at Banner UMC-Tucson and associated clinics. Methods: A single-center, institutional review board-approved retrospective study was conducted for adults receiving EPOCH-based regimens. Data were collected by chart review for each patient. Descriptive statistics were utilized for analysis. Main Results: A total of 35 patients received 137 cycles of an EPOCH-containing regimen (17 [12.4%] inpatient), 55 [40.1%] outpatient, and 66 [48.2%] hybrid inpatient and outpatient). Two inpatient cycles (11.8%), 11 outpatient cycles (20%), and 10 hybrid cycles (15.15%) resulted in admissions for neutropenia. Six inpatient cycles were delayed (35.3%) for disease-related procedures and one (5.9%) was delayed for low blood counts. Five (9.1%) outpatient cycles were delayed due to logistics (i.e. insurance, scheduling errors) and two (3.6%) outpatient cycles were delayed due to disease-related adverse events (bowel obstruction, chest pain). Transitioning EPOCH to the outpatient setting decreased overall costs for hospital stays by $19,792 per cycle with an overall cost savings to the health-system of 1,114,992 dollars with 432 bed days saved. Conclusions: EPOCH-containing regimens can be safely transitioned into the outpatient setting, side effects can be monitored and outcomes optimized, to better adapt treatment strategies for individualized patient therapies. As new healthcare payment models are developed, outpatient treatments allow for adaptive financial options both for the payor and the patient.