{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:07:09Z","timestamp":1789564029054,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Early discontinuation of empirical antibiotic therapy (EAT) is non\u2010inferior to continuation of EAT until absolute neutrophil count (ANC) \u2265500\u00a0cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      for children with high\u2010risk febrile neutropenia (FN). In this prospective trial\u2010based economic evaluation, we aimed to estimate the healthcare resource utilization and cost\u2010effectiveness of early discontinuation of EAT versus continuation of EAT in children with high\u2010risk FN in India.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Clinically stable children aged 2\u201318\u00a0years with acute leukemia, high\u2010risk FN, and afebrile status for \u226572\u00a0h were randomized to stop EAT or continue EAT until ANC recovery. Healthcare utilization data, including antibiotic exposure, antifungal use, hospitalization, laboratory investigations, and organ support, were prospectively collected. Individual patient data were used to estimate the direct medical costs, quality\u2010adjusted life years (QALYs), and the incremental monetary benefit (iNMB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 76 patients were included in the stop arm and 73 in the continuation arm. Early discontinuation reduced total antibiotic duration and antifungal use. The mean total cost per patient was \u20b967,894 in the stop arm versus \u20b977,291 in the continuation arm (difference: \u20b99397). Antibiotic and antifungal expenditures were lower with early discontinuation of EAT. Mean QALYs were 0.0255 in the stop arm and 0.0236 in the continuation arm (difference: 0.0018). The iNMB favored early discontinuation (\u20b99785.6; 95% credible interval \u20b96949.1\u2013\u20b912,534.2). In probabilistic sensitivity analysis, early discontinuation was cost\u2010effective in 100% of simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early discontinuation of EAT in children with high\u2010risk FN is cost\u2010saving and the preferred strategy for children with acute leukemia and high\u2010risk FN in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70703","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:31:53Z","timestamp":1789561913000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of Early Empirical Antibiotic Cessation in Pediatric High\u2010Risk Febrile Neutropenia"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0112-4051","authenticated-orcid":false,"given":"Rupak Kumar","family":"Giri","sequence":"first","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2939-5400","authenticated-orcid":false,"given":"Manraj Singh","family":"Sra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS)  New Delhi India"},{"name":"Division of Hematology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhosh","family":"Kumar Kn","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7095-6740","authenticated-orcid":false,"given":"Archana","family":"Sasi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-331X","authenticated-orcid":false,"given":"Deepam","family":"Pushpam","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS)  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-8408","authenticated-orcid":false,"given":"Atul","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. 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