Treating children with intravenous antibiotics at home is just as effective and safe as hospital treatment but substantially more cost-effective for families and hospitals, a new study has found.
The study involved 188 children, aged six months to 18 years, who presented to The Royal Children’s Hospital’s (RCH) emergency department with moderate to severe cellulitis. Participants were randomly assigned either intravenous ceftriaxone at home with a visiting nurse and doctor or intravenous flucloxacillin at hospital.
The research, led by the Murdoch Children’s Research Institute (MCRI), is the first to compare home IV antibiotic treatment with standard hospital care in a randomised study of children.
MCRI lead researcher Dr Laila Ibrahim, a PhD student at the University of Melbourne, says families incur a three-fold burden of cost when their child is treated in hospital rather than home, a factor often overlooked by clinicians.
The study found the RCH cost per patient was $1965 for the home group over two days of treatment, compared to $3775 for the hospital group.
The mean cost incurred per family was $182 for the home group and $593 for the hospital group.
Treatment failure occurred in two per cent of children at home and seven per cent of children in hospital while adverse reactions such as diarrhea and vomiting happened less frequently at home and there was no difference in complication rates, which were very low.
MCRI and University of Melbourne Associate Professor Penelope Bryant, head of the RCH Hospital-in-the-Home program and senior author of the study, says the potential for savings across Australia is “enormous”.
She adds hospitals could save a collective $4.3 million a year nationally and families $990,150, just for this one infection. This is based on a conservative estimate that 2,415 children who attend an emergency department with cellulitis annually are eligible for home intravenous treatment.
“Its use reduces hospital-acquired infections, negative psychosocial impact and the inconvenience of hospital admission,” said A/Professor Bryant.
“But despite the benefits, home treatment remains uncommon in children, in part because of the lack of evidence for the safety and cost-effectiveness of this strategy.
“If this study could be replicated in multiple infections needing antibiotics such as urinary tract infection and febrile neutropenia, and even viral infections needing nursing observations, then the savings would be significant.”
Dr Ibrahim said, “Outpatient antibiotic treatment following a hospital admission has become a widely endorsed model of care worldwide in the past decade.
“This study shows the clinical and cost benefits of avoiding hospital admission altogether.”
Researchers from the University of Melbourne and The Royal Children’s Hospital also contributed to the findings.