A Home Infliximab Infusion Program

Introduction: Infliximab is a promising advance in the treatment of pediatric inflammatory bowel disease. Infliximab is an effective therapy for selected children with Crohn disease but is both costly and time consuming. Objectives: To analyze our center's experience with a program of home-based infliximab infusion. Methods: Between September, 2001, and October, 2003 we reviewed the charts of all children receiving home infliximab infusions focusing on cost, safety, and patient satisfaction. Children were enrolled in the home infusion program if they were compliant with hospital-based infliximab infusions and other medications, had no adverse events during hospital-based infliximab infusions, were in remission and had access to experienced pediatric homecare nursing. Results: Ten children received 59 home infusions with a dose range of 7.5 to 10 mg/kg/dose. The calculated average savings per patient was $1335/100 mg infliximab. Home infusions ranged from 2 to 5 hours. Since infusions could be performed any day of the week, school absenteeism was decreased. The average patient satisfaction rating for home infusions was 9 on a scale from 1 to 10 (10 = most satisfied). Three patients experienced difficulty with IV access requiring multiple attempts, but all were able to receive their infusions. One infusion was stopped because of arm pain above the IV site. This patient had his next infusion in the hospital before returning to the home infusion program. No severe adverse events (palpitations, blood pressure instability, hyperemia, respiratory symptoms) occurred during home infusions. Conclusions: In our carefully selected patients, infliximab infusions administered at home were safe and are cost-effective. Patients and families preferred home infusions, since time missed from school and work was reduced.