Ambulatory high-dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost-effective

Kris M. Mahadeo, Ruth Santizo, Lindsay Baker, Joan O Hanlon Curry, Richard Gorlick, Adam S. Levy

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: We describe the safety, feasibility, and provide a cost-estimate of outpatient high-dose methotrexate administration (HDMTX) among an urban, underserved population. Procedure: A retrospective analysis of ambulatory HDMTX administration among osteosarcoma patients, at Montefiore Medical Center's Children's Hospital (Bronx, NY) was performed. HDMTX (12g/m 2) was given intravenously (IV) over 4hr after urine alkalinization. Patients were discharged home to continue IV hydration and alkalinization delivered via a home infusion pump. Families were instructed to monitor urine pH overnight and management was adjusted according to our institution's treatment algorithm until MTX level ≤0.1μmol/L. A cost estimate was performed to assess the difference in costs for outpatient versus hypothetical inpatient administrations. Results: Of the 97 ambulatory HDMTX administrations, 99% were successfully completed. One patient failed outpatient administration secondary to home infusion pump malfunction. This patient successfully completed subsequent courses as an outpatient. Most patients (72%) had a MTX level of <10μmol/L at 24hr post-HDMTX. No patients were found to have a MTX level of >50μmol/L at 24hr. About 26% of courses were associated with grade III or IV neutropenia, 4% were associated with grade III or IV thrombocytopenia and 1% were associated with grade III/IV leukopenia. Compared to a hypothetical hospital inpatient stay, the hospital costs for ambulatory HDMTX were an average of $1400 less per cycle. Conclusion: Ambulatory HDMTX administration among an underserved, urban population is safe, feasible, and cost-effective.

Original languageEnglish (US)
Pages (from-to)1296-1299
Number of pages4
JournalPediatric Blood and Cancer
Volume55
Issue number7
DOIs
StatePublished - Dec 2010

Fingerprint

Osteosarcoma
Methotrexate
Pediatrics
Costs and Cost Analysis
Outpatients
Infusion Pumps
Urban Population
Vulnerable Populations
Inpatients
Urine
Hospital Costs
Leukopenia
Neutropenia
Length of Stay
Safety

Keywords

  • Chemotherapy
  • Cost-effective
  • Methotrexate
  • Osteosarcoma
  • Pediatric oncology
  • Underserved

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Ambulatory high-dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost-effective. / Mahadeo, Kris M.; Santizo, Ruth; Baker, Lindsay; Curry, Joan O Hanlon; Gorlick, Richard; Levy, Adam S.

In: Pediatric Blood and Cancer, Vol. 55, No. 7, 12.2010, p. 1296-1299.

Research output: Contribution to journalArticle

Mahadeo, Kris M. ; Santizo, Ruth ; Baker, Lindsay ; Curry, Joan O Hanlon ; Gorlick, Richard ; Levy, Adam S. / Ambulatory high-dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost-effective. In: Pediatric Blood and Cancer. 2010 ; Vol. 55, No. 7. pp. 1296-1299.
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AB - Background: We describe the safety, feasibility, and provide a cost-estimate of outpatient high-dose methotrexate administration (HDMTX) among an urban, underserved population. Procedure: A retrospective analysis of ambulatory HDMTX administration among osteosarcoma patients, at Montefiore Medical Center's Children's Hospital (Bronx, NY) was performed. HDMTX (12g/m 2) was given intravenously (IV) over 4hr after urine alkalinization. Patients were discharged home to continue IV hydration and alkalinization delivered via a home infusion pump. Families were instructed to monitor urine pH overnight and management was adjusted according to our institution's treatment algorithm until MTX level ≤0.1μmol/L. A cost estimate was performed to assess the difference in costs for outpatient versus hypothetical inpatient administrations. Results: Of the 97 ambulatory HDMTX administrations, 99% were successfully completed. One patient failed outpatient administration secondary to home infusion pump malfunction. This patient successfully completed subsequent courses as an outpatient. Most patients (72%) had a MTX level of <10μmol/L at 24hr post-HDMTX. No patients were found to have a MTX level of >50μmol/L at 24hr. About 26% of courses were associated with grade III or IV neutropenia, 4% were associated with grade III or IV thrombocytopenia and 1% were associated with grade III/IV leukopenia. Compared to a hypothetical hospital inpatient stay, the hospital costs for ambulatory HDMTX were an average of $1400 less per cycle. Conclusion: Ambulatory HDMTX administration among an underserved, urban population is safe, feasible, and cost-effective.

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