Characteristics, safety and cost‐effectiveness analysis of self‐administered outpatient parenteral antibiotic therapy via a disposable elastomeric continuous infusion pump at two county hospitals in Houston, Texas, United States

Abstract

What is known and objective Outpatient parenteral antibiotic therapy (OPAT) is an attractive option for patients who require parenteral antimicrobials as outpatients. Few OPAT studies have assessed the impact of IV antibiotic therapy via elastomeric continuous pumps, with most having been conducted outside the United States and few in county hospitals. The OPAT program in Harris Health system, the county hospital system of Houston, Texas, United States, has implemented a disposable elastomeric continuous infusion pump (eCIP) for self‐administered intravenous antibiotics (s‐OPAT) since December 2018. Our goal was to describe the clinical characteristics of patients discharged with an eCIP, as well as the safety and cost‐effectiveness of this pump. Methods We retrospectively analysed patients discharged from Harris Health hospitals between 12/2018 and 02/2021 with s‐OPAT via eCIP at home. We extracted various patient characteristics and outcomes related to OPAT. Results and discussion Among 481 OPAT patients during the study period, 91 patients received s‐OPAT via eCIP. A total of 1925 days of s‐OPAT were administered at home, with a median duration of 12 days. Eighty‐three patients (93.4%) achieved a cure from infection, six patients (6.6%) had side effects, and nine patients (9.9%) experienced 30‐day hospital readmission. Twenty‐two patients (24.2%) presented to the ED during s‐OPAT, with 13 patients (14.3%) presenting with PICC line concerns. We estimated that s‐OPAT via eCIP saved $2,360,500 to $3,503,900 compared to inpatient‐only therapy. What is new and conclusion Our study showed that patients with s‐OPAT via eCIP had a high cure rate with a relatively low incidence of side effects and 30‐day hospital readmission. ED visits during therapy were relatively high, which indicates the necessity of close patient monitoring via the OPAT program. eCIP appears to be a good option to facilitate an early disposition of patients in county hospitals.

Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients—A Systematic Review

“…Whilst no outcome data regarding cure or failure of treatment were reported by Cave et al, previous OPAT studies have found EMPs to be clinically effective. However, the authors note the low levels of evidence supporting this [ 6 , 8 , 9 ].…”

“…Use of EMPs for antibiotics is not new but is mainly confined to the outpatient setting, where studies have shown this method of administration to be safe and effective [ 8 , 9 ]. EMPs are included in the United Kingdom (UK) good practice guidelines for Out-patient Parenteral Antibiotic Therapy (OPAT) [ 10 ].…”

Retrospective Cohort Study of the 12-Month Epidemiology, Treatment Patterns, Outcomes, and Health Care Costs Among Adult Patients With Complicated Urinary Tract Infections

“…In most cases, IV antibiotics were administered for the index cUTI episode, and patients were administered IV antibiotic therapy in a physician’s office or infusion suite. While OPAT is increasingly being used as a cost-efficient measure to facilitate early hospital discharge and minimize hospitalizations in otherwise healthy patients [ 40–42 ], the average 14-day OPAT costs exceeded $2500 across all cUTI study population subgroups. In addition to 14-day cUTI-related cost considerations with OPAT, data indicate that OPAT-related adverse events and subsequent hospital admissions/readmissions occur frequently [ 43–51 ].…”

A review of evidence, antimicrobial stability, and feasibility considerations for OPAT continuous infusion

“…6 The use of self-administered elastomeric CI pumps for a total of 1925 OPAT days resulted in cost avoidance of $2.3 to $3.5 million relative to an inpatient-only treatment course. 6 A study in Spain among patients receiving CI OPAT via elastomeric devices (with piperacillin/tazobactam, 43%; meropenem, 20%; ceftazidime, 25%; ceftolozane/tazobactam, 3%; and cloxacillin, 2%) showed a similar cost avoidance of €745,290.55 associated with 1409 OPAT days compared with inpatient days. 7 Data are limited regarding cost comparisons among various OPAT delivery methods.…”

“…26 More recently, penicillin was shown to be frequently prescribed and administered via elastomeric systems for neurosyphilis and other diseases, which resulted in substantial institutional cost savings. 6 Ampicillin, which has more limited stability than penicillin, has been less frequently used in elastomeric systems and may require the use of ambulatory electronic pump systems. Some stability data are available for ampicillin in an elastomeric device as well as in a plastic container (72 h refrigerated; 20 mg/mL concentration).…”