Applying the ‘COST’ (Culture, Oversight, Systems Change, and Training) Framework to De-Adopt theNeutropenic Diet

De-adoption is the discontinuation of ineffective, inefficient, unnecessary, or harmful health care services that provide no additional benefit relative to their cost.1,2 Often, processes or practices that were once promising, or perhaps even evidence based, are found to have limited value as new evidence emerges.1 Increasing health care expenditures and a goal of avoiding the harms of overuse of health care have led to various initiatives aimed at reducing low-value care, such as the “Choosing Wisely Campaign” in the United States and the “do not do” list by The National Institute for Health and Care Excellence in the United Kingdom.