Evaluation of ifosfamide based chemotherapy regimens for sarcomas in the outpatient setting (IPOP): Cost savings and safety profile.

7 Background: Administration of inpatient chemotherapy has been a financial burden with the cost projected to reach $246.6 billion by 2030. Moffitt Cancer Center developed an inpatient-outpatient (IPOP) service in 2017 to administer specific chemotherapy regimens in an ambulatory setting. This study aims to evaluate the clinical and financial outcomes of sarcoma regimens, specifically IE (ifosfamide and etoposide) and MAI (mesna, doxorubicin, and ifosfamide), administered in an ambulatory setting. Methods: This was a single-centered, retrospective cohort study at an NCI-designated cancer center. Adults (18-60 years) received bolus ifosfamide-based IE or MAI regimens. The primary endpoint was inpatient bed days saved. Secondary outcomes compared readmission bed days, urgent care visits, readmission rate, treatment delays, dose reductions, prolonged admissions, grade 3 or higher adverse effects, and the associated financial effects of treatment. Results: A total of 58 patients were included with 29 (127 cycles) in the IPOP arm and 29 (105 cycles) in the inpatient arm. Patients in the IPOP arm saved 470 inpatient bed days, which estimates a cost savings of $1,439,610 in operational and non-operational costs based on the average non-profit hospital bed day in Florida. For IPOP and inpatient arms respectively, readmission bed days accounted for 57.4 and 83.8 days. The average duration of readmission was 2.5 days versus 4.2 days. Treatment delays or dose reductions did not occur in 89.8% of the IPOP arm cycles and 95.2% in the inpatient arm cycles. Most patients were able to complete the intended number of chemotherapy cycles for the IPOP and inpatient arms (93.1% vs 96.6%). Grade 3 or higher adverse effects were observed in both arms with similar rates for IPOP versus inpatient arms respectively. Specifically, grade 3 or higher adverse effects included neutropenia (26.8% vs 34.4%), thrombocytopenia (19.7% vs 18.3%), febrile neutropenia (15.0% vs 18.3%), diarrhea (0.0% vs 1.9%), and nausea (0.0% vs 1.0%) for IPOP versus inpatient arms. Conclusions: IPOP arm demonstrated a substantial reduction of inpatient bed days, representing significant cost savings. The number of treatment cycles leading to readmissions or urgent care visits were similar between the two arms. Grade 3 or higher adverse effects were comparable across both groups. These findings indicate that ifosfamide-based chemotherapy regimens, such as IE and MAI, can be safely administered in an outpatient setting with decreased inpatient bed days.