NEW ORLEANS--Since Duke University moved part of its autologous
bone marrow transplantation (ABMT) service to an outpatient setting,
"the hospital has saved bundles, and the patients couldn't
be happier," William Peters, MD, director of bone marrow
transplantation and professor of medicine, told reporters at the
American Cancer Society Science Writers Seminar.
The high cost of bone marrow transplant is largely due to the
extended hospitalization, he said, so when you reduce this factor
by using an intensive outpatient clinic instead, the savings mount.
More than 350 breast cancer patients at Duke have received high-dose
chemotherapy as inpatients, then have undergone ABMT as outpatients,
staying in a neighboring hotel where they are minutes away from
clinic appointments and emergency care, Dr. Peters said.
The patient, by protocol, has a caregiver with her, but there
are no medical personnel on the hotel premises. The "rapid
readmission" capability is the key to making this work. The
hospital reserves one bed for every eight outpatients, so emergency
admissions are possible.
Of the first 295 patients, about 95% were discharged soon after
chemotherapy, and 68% of these women were subsequently managed
almost totally as outpatients. Readmission was never required
for 47%, and 21% required brief hospital admissions of less than
24 hours, primarily for acute management of febrile neu-tropenia.
The main reason for readmis-sion after initial chemotherapy was
The outpatient management approach has reduced the average number
of hospital days from 25 to 8. This directly affects treatment
cost, since hospitalization runs $1,945 per day, compared with
the daily hotel room rate of $55, Dr. Peters said.
The patients have been universally in favor of the change. "In
surveys, almost all the women have referred to the hospital stay
as some sort of prison. As outpatients, they have more freedom,
more control, and more privacy," he said. "We thought
they would have some anxiety, but most had none at all."