In the UK, methicillin-resistant Staphylococcus aureus (MRSA)-associated skin and soft tissue infections (SSTIs) are predominantly managed in the hospital using intravenous (IV) glycopeptides. We set out to explore the potential for and relative healthcare costs of earlier hospital discharge through switch to oral antibiotic therapy (linezolid or rifampicin and doxycycline) or continuation of IV therapy (teicoplanin) via an outpatient parenteral antimicrobial therapy (OPAT) service. Over 16 months, 173 patients were retrospectively identified with MRSA SSTI, of whom 82.8 % were treated with IV therapy. Thirty-seven patients were potentially suitable for earlier discharge with outpatient therapy. The model assumed 3 days of inpatient management and a maximum of 14 days of outpatient therapy. For the status quo, where patients received only inpatient care with IV therapy, hospital costs were calculated at £12,316 per patient, with 97 % of costs accounted for by direct bed day costs. The mean total cost savings achievable through OPAT or oral therapy was estimated to be £6,136 and £6,159 per patient treated, respectively. A significant proportion of patients with MRSA SSTI may be suitable for outpatient management with either oral therapy or via OPAT, with the potential for significant reduction in healthcare costs.
IPCW) method and the Cox model using treatment as a time-dependent covariate were used as sensitivity analyses. RESULTS: Overall, 71% of patients randomized to dexamethasone crossed over to bortezomib. The primary analysis led to a hazard ratio of 0.59 (95%CI: [0.32,0.86]) for bortezomib versus dexamethasone, compared to 0.77 (95%CI: [0.61,0.97]) using the ITT approach. The results of the secondary analyses were consistent with the primary analysis. The IPCW provided results, which were very sensitive to the choice of the time interval. Lastly, the Cox model with treatment as a time-dependent variable resulted in a counter-intuitive higher hazard ratio than the ITT analysis, consistent with results from simulation studies indicating this approach is biased. CONCLUSIONS: Adjusting for crossover led to a decrease of the hazard ratio from 0.77 to 0.59, and resulted in wider confidence intervals than the ITT analysis. Additional analyses are required to assess the performance of the IPCW method compared to the IPE algorithm and the RPSFT model under different scenarios.
long-acting injectable risperidone. METHODS: Retrospective analysis (Jan 2006-Dec 2008 of Texas Medicaid data was conducted for patients Ͼϭ 18 years old with schizophrenia (ICD-9: 295.xx). Patients who initiated either oral (oral cohort) or injectable risperidone (injectable cohort), had no prior risperidone for at least 12 months, and had at least one additional prescription following initiation were included. Medical care services and costs were compared within and between cohorts for 12 months pre-and post-initiation using paired-, independent t-tests and McNemar tests. RESULTS: 1544 patients were included (oral cohort: nϭ1261, mean age ϭ 38yrs, 54% male; injectable cohort: nϭ283, mean ageϭ39yrs, 61% male). The injectable cohort (4.6, SDϭ2.9) had a significantly higher mean Chronic Disease Score (CDS) compared to the oral cohort (3.2, SDϭ2.9) (pϽ0.05). The percent of patients with at least one psychiatric-related hospitalization significantly decreased by 10.6% in the injectable cohort (25.0% to 14.5%; pϽ0.05) compared to 6.1% in the oral cohort (18.7% to 12.6%; pϽ0.05), and average hospital length of stay (LOS) was significantly reduced by 2.5 days (4.4 to 1.9 days) versus 0.9 days (2.6 to 1.7 days), respectively (pϽ0.
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