Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: Comparing hospital and home care

AbstractBackgroundA cost-effectiveness evaluation comparing home-based and hospital-based treatment with intravenous antibiotics for respiratory exacerbations in adults with cystic fibrosis (CF) has not been previously undertaken.MethodsThe study was conducted in a UK adult CF centre from a health service perspective. Clinical outcome and resource use data were obtained from a retrospective one-year study and combined with unit cost data in an incremental economic analysis. The primary outcome measure was percentage change in FEV1; “effectiveness” was defined as maintenance of baseline average FEV1 over the one-year study period.Results116 patients received 454 courses of intravenous antibiotics. At the end of 1 year, there had been a mean percentage decline in FEV1 compared with baseline average for home-treated patients but an improvement for hospital-treated patients (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p=0.003). Treatment was deemed “effective” in more hospital (58.8%) than home (42.6%) patients. The cost of hospital treatment was higher than home treatment (mean difference £9005, 95% CI 3507 to 14,700, p