Clinical and Economic Impact of the Mexico in Alliance With St. Jude Golden Hour Collaborative in a Mexican Hospital

Abstract

Background

In low- and middle-income countries, infections remain the leading cause of treatment-related mortality in pediatric patients with cancer. To address this, the Golden Hour Collaborative—developed in Mexico in alliance with St. Jude—was designed to promote timely antibiotic administration for febrile pediatric hemato-oncology patients through a multidisciplinary approach, continuous caregiver and staff training, standardized protocols, and supply availability. This study evaluates the clinical and economic impact of implementing the MAS Collaborative at the ISSEMyM Maternal–Infant Hospital.

Procedure

A prospective cohort study with historical controls was conducted. Outcomes were analyzed with nonparametric tests. Costs per febrile neutropenia (FN) episode were estimated using official state cost tables (adjusted to 2025 USD).

Results

A total of 160 episodes were analyzed: 80 in the pre-intervention period (2015–2018) and 80 in the post-intervention period (2019–2022). After implementation, the proportion of patients receiving antibiotics within 60 min increased from 3.8% to 98% (median time-to-antibiotic (TTA) 198 vs. 42 min, p < 0.001). Outcomes improved with shorter hospital stays (9 vs. 8 days, p = 0.03), reduced pediatric intensive care unit (PICU) admissions (20% vs. 7.5%, OR 0.32, p = 0.02), decreased septic shock (25% vs. 8.7%), and no infection-related deaths post-intervention (vs. 7.5% pre-intervention). Discharge without complications rose from 50% to 83%. Mean healthcare cost decreased from USD 8,580 to USD 2,835.

Conclusion

In this resource-limited setting, the MAS Collaborative shows that multidisciplinary, context-adapted interventions can improve timeliness of care, reduce complications and mortality, and lower short-term costs, highlighting their potential for scalability in LMICs.