OBJECTIVE: We compared costs and outcomes associated with home and hospital-based treatment of febrile neutropenia (FN) among pediatric oncology patients. METHODS: In a historical case series study we gathered data from charts of University of New Mexico (UNM) patients who were treated at home (n=36, 72 treatments) and University of Arizona (UA) patients who were treated in the hospital (n=27, 72 treatments). All health care resources and treatment outcomes were obtained for each episode of FN. Uniform charge values were applied to each health care resource. Outcome data included positive blood cultures and days to resolution of FN, based upon fever and absolute neutrophil count. We applied Mann-Whitney U and chi square tests. Sensitivity analyses were performed using charges per episode. RESULTS: Both groups were similar for gender , age, types of diseases, and FN-inducing chemotherapies. More of the home-treated patients were treated with granulocyte colony stimulating factor (58 vs. 42, p=.004). The median total estimated charge per episode was $9166 for UA patients versus $5117 for UNM patients (p<.001). Lower charges for UNM patients, included hospital days, microbiology cultures, blood counts, serum chemistries, physician visits, radiologic studies, and serum antibiotic levels. Positive blood cultures occurred more frequently in UA patients (30.6% vs. 11.1%, p=.012) and mean days to resolution of FN was 8.6 versus 7.6 for UNM patients (NS). Results were stable across all sensitivity analyses. CONCLUSION: With careful supervision by a pediatric oncology center, uncomplicated FN can be treated by home care, with substantial savings.