Introduction

The natural history of cystic fibrosis (CF) is characterised by repeated infective respiratory exacerbations leading to continued decline in lung function. Patients generally undergo treatment for exacerbations with 14-day courses of intravenous antibiotics administered either in hospital or at home. As home treatment is well established but there are no robust evaluations of cost-effectiveness, the aim of this study was to compare the economic impact of home and hospital treatment.

Methods

Patients from an adult CF unit participated in this retrospective one-year study. The Local Research Ethics Committee was informed of the study and approval was deemed not necessary. Lung function (forced expiratory volume in one second, FEV₁) was chosen as the clinical outcome measure and data were collected from the patients' clinical records. Fixed, variable, and patients' own resource data were collected from patients' clinical records, through observation, and questionnaire use. Antibiotic costs only are reported here.

Preliminary results

• 116 (50% male, 50% female) patients were recruited from the total unit population of 240 patients. The mean age was 26 years (range 16 to 47).
• Patients received a total of 454 courses of i.v. antibiotics during the one-year study period. The mean number of courses per patient was 4 (range 1 to 9).
• In 213 courses (46.9%) the intention was to treat at home and in 241 courses (53.1%) the intention was to treat in hospital. However, in practice treatment was divided between home and hospital in 76 of these courses.
• The total number of days of i.v. treatment was 6,951 comprising 3,625 days treatment at home and 3,326 days treatment in hospital. The mean length of a course of treatment was 15 days (range 3 to 170).
• The percentage improvement in FEV₁ during each course was calculated; the difference between home and hospital was statistically significant (p<0.001).

• The total cost of prescribed i.v. antibiotics was £986,769, of which £546,812 accounted for antibiotic treatment at home and £439,957 accounted for antibiotic treatment in hospital. The mean cost per patient per year was £8,507 (range £451 to £56,351).

Discussion

The preliminary results indicate a greater improvement in FEV₁ after one course of treatment for patients treated in hospital compared with those treated at home. However, a number of factors affecting outcome must be taken into account including severity of illness. The effect of these factors will be examined using regression techniques. Outcome after one year will also be assessed. The economic evaluation will compare cost-effectiveness of home and hospital treatment with i.v. antibiotics for both one course and one year of treatment.