{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:51:07Z","timestamp":1753883467733,"version":"3.41.2"},"reference-count":33,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"11","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n            <jats:title>PURPOSE<\/jats:title>\n            <jats:p>Febrile neutropenia (FN) is a common cancer complication in children. A growing body of evidence suggests that home-based care with oral antibiotics is safe and effective in carefully selected children with low-risk (LR) FN. This study aimed to assess the efficacy and safety of oral levofloxacin versus oral amoxicillin-clavulanate\/ciprofloxacin in the management of LR-FN in children with cancer over a time horizon of 7 days from the National Cancer Institute (NCI) perspective.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>PATIENTS AND METHODS<\/jats:title>\n            <jats:p>This is a randomized controlled study conducted at the NCI from December 2021 to September 2022, including children and adolescents age between 3 and 18 years who presented to the emergency room with LR-FN criteria with the exclusion of patients younger than 3 years and patients with Down syndrome. One hundred LR-FN episodes were enrolled in each arm. Patient demographics, microbiologic data, and outcomes were collected at different time points. A decision analytic model was created to compare the two treatment strategies. The outcome measures included quality-adjusted FN episodes, costs, and incremental cost-effectiveness ratios.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>Levofloxacin was a safe and effective treatment option for LR-FN. It proved to be the dominant strategy against amoxicillin-clavulanate\/ciprofloxacin with an incremental quality-adjusted life-year (QALY) of 0.0001 and a lower cost of 62.4996 Egyptian pounds (EGPs) in the treatment of home-based LR-FN with a willingness to pay a threshold of 77,520 EGPs per QALY (1 gross domestic product\/capita).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>For the treatment of FN in pediatric patients with cancer, levofloxacin offers a cost-saving option with improved survival benefits over a 7-day time horizon from the NCI perspective. These findings will help health care decisions regarding the allocation of health care system resources to improve supportive care for patients with LR-FN.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/go.24.00182","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T19:59:14Z","timestamp":1745438354000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of Oral Levofloxacin Versus Amoxicillin-Clavulanate\/Ciprofloxacin for Outpatient Management of Low-Risk Febrile Neutropenia in Children With Cancer in Egypt"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5355-8225","authenticated-orcid":true,"given":"Reham Abdelaziz","family":"Khedr","sequence":"first","affiliation":[{"name":"Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt"},{"name":"Children's Cancer Hospital of Egypt, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebtehal","family":"Ali","sequence":"additional","affiliation":[{"name":"Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeinab Ahmad","family":"Elshafei","sequence":"additional","affiliation":[{"name":"Pharmacoeconomic Unit, Egyptian Drug Authority (EDA), Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadir","family":"Ahmed El-Mahallawy","sequence":"additional","affiliation":[{"name":"Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6484-0875","authenticated-orcid":true,"given":"Nashwa","family":"Ezz Eldeen","sequence":"additional","affiliation":[{"name":"Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt"},{"name":"Children's Cancer Hospital of Egypt, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2005.07.010"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22205"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1086\/499352"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.16.3038"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1086\/339215"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.71.7017"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1179\/2047773215Y.0000000030"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/molecules26237153"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/321846"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199856030-00013"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044097"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02983537"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.19.00344"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1992.10.2.316"},{"key":"e_1_3_6_16_2","first-page":"1387","article-title":"Risk factors for infections, antibiotic therapy, and its impact on cancer therapy outcomes for patients with solid tumors","volume":"11","author":"Kube\u010dek O","year":"2021","unstructured":"Kube\u010dek O, Paterov\u00e1 P, Novosadov\u00e1 M: Risk factors for infections, antibiotic therapy, and its impact on cancer therapy outcomes for patients with solid tumors. Life (Basel) 11:1387, 2021","journal-title":"Life (Basel)"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-05113-4"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573396314666180508121625"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12512"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-314807"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.10208"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2013.06.014"},{"volume-title":"Framework for Developing Cost-Effectiveness Analysis Threshold: The Case of Egypt","author":"Fasseeh A","key":"e_1_3_6_23_2","unstructured":"Fasseeh A, Elezbawy B, Korra N, et al: Framework for Developing Cost-Effectiveness Analysis Threshold: The Case of Egypt. Virtual ISPOR Europe 2021. https:\/\/www.ispor.org\/docs\/default-source\/euro2021\/cet-egypt-poster-v9-pdf.pdf?sfvrsn=5f1648d_0"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04132-0"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jped.2020.05.002"},{"key":"e_1_3_6_26_2","doi-asserted-by":"publisher","DOI":"10.1086\/313677"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1086\/515104"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.45.8109"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.3960\/jslrt.20008"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/CAD.0000000000000187"},{"key":"e_1_3_6_31_2","first-page":"5718716","article-title":"Amoxicillin\/clavulanic acid-induced agranulocytosis: A case report and review of the literature","volume":"2019","author":"Armas Villalba A","year":"2019","unstructured":"Armas Villalba A, Haq M, Zhang C, et al: Amoxicillin\/clavulanic acid-induced agranulocytosis: A case report and review of the literature. Case Rep Hematol 2019:5718716, 2019","journal-title":"Case Rep Hematol"},{"key":"e_1_3_6_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0b013e3181a4695f"},{"key":"e_1_3_6_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-023-08065-y"},{"key":"e_1_3_6_34_2","doi-asserted-by":"publisher","DOI":"10.1071\/AH19061"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO.24.00182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T19:59:22Z","timestamp":1745438362000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO.24.00182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4]]},"references-count":33,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1200\/GO.24.00182"],"URL":"https:\/\/doi.org\/10.1200\/go.24.00182","relation":{},"ISSN":["2687-8941"],"issn-type":[{"type":"electronic","value":"2687-8941"}],"subject":[],"published":{"date-parts":[[2025,4]]},"assertion":[{"value":"2024-04-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-12","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2400182"}}