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

J Cyst Fibros. 2005 Dec;4(4):239-47. doi: 10.1016/j.jcf.2005.08.003. Epub 2005 Oct 19.


Background: A 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.

Methods: The 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 FEV(1); "effectiveness" was defined as maintenance of baseline average FEV(1) over the one-year study period.

Results: 116 patients received 454 courses of intravenous antibiotics. At the end of 1 year, there had been a mean percentage decline in FEV(1) 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 9,005 pounds, 95% CI 3,507 to 14,700, p<0.001). The mean ICER was 46,098 pounds (2.5th and 97.5th percentiles -374,044 and 362,472).

Conclusions: Hospital treatment was more effective but more expensive than home treatment. Potential methods to improve outcome at home should be considered but these may have resource implications.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use*
  • Chi-Square Distribution
  • Cost-Benefit Analysis
  • Cystic Fibrosis / microbiology*
  • Female
  • Forced Expiratory Volume / drug effects
  • Home Care Services / economics*
  • Hospitals, Special / economics*
  • Humans
  • Infusions, Intravenous
  • Lung Diseases / drug therapy*
  • Lung Diseases / microbiology
  • Male
  • Retrospective Studies
  • Treatment Outcome
  • United Kingdom


  • Anti-Bacterial Agents