Clinical Utility and Cost Effectiveness of Long-Acting Lipoglycopeptides Used in Deep-Seated Infections among Patients with Social and Economic Barriers to Care

Abstract

The use of long-acting lipoglycopeptides (LaLGPs) in serious, deep-seated infections is of increasing interest. The purpose of this study is to evaluate the economic and clinical utility of LaLGPs in patients requiring protracted antibiotic courses who are not ideal candidates for oral transition or outpatient parenteral antibiotic therapy (OPAT). This is a retrospective, observational, matched cohort study of adult patients who received a LaLGP. Patients were matched 1:1 to those who received standard of care (SOC). Cost effectiveness was evaluated as total healthcare-related costs between groups. Clinical failure was a composite endpoint of mortality, recurrence, or need for extended antibiotics beyond planned course within 90 days of initial infection. There was no difference in clinical failure between the two cohorts (22% vs. 30%; p = 0.491). Six patients in the SOC cohort left against medical advice (AMA) prior to completing therapy. Among those who did not leave AMA, receipt of LaLGPs resulted in a decreased hospital length of stay by an average of 13.6 days. The average total healthcare-related cost of care was USD 295,589 in the LaLGP cohort compared to USD 326,089 in the SOC cohort (p = 0.282). Receipt of LaLGPs may be a beneficial treatment option for patients with deep-seated infections and socioeconomic factors who are not candidates for oral transition or OPAT.

A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections

“…Moreover, the duration of hospitalization was 22.9 days in the LaLGP group compared to 32 days in the standard-of-care group [40]. Although LaLGP were associated with numerical, though not statistically significant, cost savings and reduced length of stay versus standard of care, the administration of LaLGP may be beneficial for patients with deep-seated, Gram-positive bacterial infections who have socioeconomic factors that preclude oral transition, or OPAT [40]. Finally, another study evaluating the impact of dalbavancin on both hospital length-of-stay and treatment-related costs in a cohort of patients with diverse Gram-positive bacterial infections reported that a median of EUR 8259 and 14 hospital days per patient who received dalbavancin therapy were saved.…”

“…Several studies have evaluated the cost-effectiveness of dalbavancin compared to other treatment options for various infections [39][40][41]. BJI correlates with a protracted hospital stay.…”

“…In a single study, patients with BJI could be discharged 10.6 days earlier, and EUR 3909 could be saved [41]. Another study compared long-acting lipoglycopeptides (LaLGP) with the standard-of-care and showed that the average total healthcare-related cost of care was USD 295,589 in the LaLGP compared to USD 326,089 in the standard-of-care cohort [40]. Moreover, the duration of hospitalization was 22.9 days in the LaLGP group compared to 32 days in the standard-of-care group [40].…”

“…Another study compared long-acting lipoglycopeptides (LaLGP) with the standard-of-care and showed that the average total healthcare-related cost of care was USD 295,589 in the LaLGP compared to USD 326,089 in the standard-of-care cohort [40]. Moreover, the duration of hospitalization was 22.9 days in the LaLGP group compared to 32 days in the standard-of-care group [40]. Although LaLGP were associated with numerical, though not statistically significant, cost savings and reduced length of stay versus standard of care, the administration of LaLGP may be beneficial for patients with deep-seated, Gram-positive bacterial infections who have socioeconomic factors that preclude oral transition, or OPAT [40].…”

Kimyrsa and Orbactiv – A Tale of Two Formulations

“…[28][29][30] Additionally, multi-dose dalbavancin for complicated infections caused by Staphylococcus species and Streptococcus species is supported by more robust data, 28,31,32 some of which included matched cohorts and comparator groups. [33][34][35][36] As such, the OF may be most useful against complicated infections caused by Enterococcus species, particularly VRE. 18,37 Perhaps, the NF can replace the OF, though it is unclear how the NF and OF will coexist going forward.…”