Outpatient ABMT at Duke Leads to Savings

NEW ORLEANS--Since Duke University moved part of its autologousbone marrow transplantation (ABMT) service to an outpatient setting,"the hospital has saved bundles, and the patients couldn'tbe happier," William Peters, MD, director of bone marrowtransplantation and professor of medicine, told reporters at theAmerican Cancer Society Science Writers Seminar.

The high cost of bone marrow transplant is largely due to theextended hospitalization, he said, so when you reduce this factorby using an intensive outpatient clinic instead, the savings mount.

More than 350 breast cancer patients at Duke have received high-dosechemotherapy as inpatients, then have undergone ABMT as outpatients,staying in a neighboring hotel where they are minutes away fromclinic appointments and emergency care, Dr. Peters said.

The patient, by protocol, has a caregiver with her, but thereare no medical personnel on the hotel premises. The "rapidreadmission" capability is the key to making this work. Thehospital reserves one bed for every eight outpatients, so emergencyadmissions are possible.

Of the first 295 patients, about 95% were discharged soon afterchemotherapy, and 68% of these women were subsequently managedalmost totally as outpatients. Readmission was never requiredfor 47%, and 21% required brief hospital admissions of less than24 hours, primarily for acute management of febrile neu-tropenia.The main reason for readmis-sion after initial chemotherapy wasfever.

The outpatient management approach has reduced the average numberof hospital days from 25 to 8. This directly affects treatmentcost, since hospitalization runs $1,945 per day, compared withthe daily hotel room rate of $55, Dr. Peters said.

The patients have been universally in favor of the change. "Insurveys, almost all the women have referred to the hospital stayas some sort of prison. As outpatients, they have more freedom,more control, and more privacy," he said. "We thoughtthey would have some anxiety, but most had none at all."