Cost Analysis of an Adult Outpatient Parenteral Antibiotic Therapy (OPAT) Programme

Wai, Amy O; Frighetto, Luciana; Marra, Carlo A.; Chan, Emily; Jewesson, Peter J.

doi:10.2165/00019053-200018050-00004

Cited by 86 publications

(61 citation statements)

References 9 publications

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“…Today, indications for OPAT programs, which are successfully used, differ among countries [23,24] . In a study which analyzed the cost of OPAT in adult patients in a tertiary training hospital in Canada between 1995 and 1998, different parenteral antibiotics were administered for different types of infections, such as bone and joint, skin and soft tissue, endocarditis and others.…”

Section: Discussionmentioning

confidence: 99%

“…This study showed that OPAT programme provided an economically attractive alternative to continued hospitalization for selected adult patients with infections requiring parenteral antimicrobial treatment. Also from the hospital perspective, the cost of therapy through the OPAT programme was approximately 13% of the cost estimated if the patient was to continue to be managed in hospital settings [23] . In another study from UK, clinical efficacy and cost-effectiveness of OPAT in 334 episodes (skin and soft tissue infections, cardiovascular infections, central nervous system infections, genito-urinary infections, etc.)…”

Section: Discussionmentioning

confidence: 99%

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Cost Analysis of Ertapenem Therapy for Urinary Tract Infections and Assessment of Its Suitability for Outpatient Parenteral Antibiotic Therapy Programme in Turkey

Örmen¹,

Türker²,

Sezak³

et al. 2018

mjima

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Introduction:The primary aim of this study was to evaluate whether there was a difference between outpatient parenteral antibiotic therapy (OPAT) and inpatient parenteral antibiotic therapy (IPAT) costs of ertapenem for urinary tract infections (UTI's) due to extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli, and to discuss suitability of ertapenem for OPAT programme of Turkey for the near future. Materials and Methods: A total of 53 patients hospitalized with the diagnosis of UTI and treated with ertapenem were retrospectively evaluated. The cost of ertapenem treatment as IPAT was actual costs retrieved from the hospital records. The estimated cost of the same antibiotic for the same patients as an OPAT programme was then calculated and the costs were compared. Results: The cost difference between IPAT and OPAT was 12.305 (€ 5783). Outpatient parenteral antibiotic therapy programme would provide an estimated 20% reduction in treatment costs. The estimated number of bed days saved, if the patients had received the treatment as OPAT, was calculated to be 583 days, which constitutes about 5% of the total number of hospitalization days. Conclusion: Applying ertapenem therapy through OPAT programme for UTIs caused by ESBL-producing Gram-negative bacilli will decrease the financial burden of health expenditures and the number of inpatient bed days in Turkey. Keywords: Ertapenem, extended-spectrum beta-lactamases, urinary tract infection, cost analysis, outpatient parenteral antibiotic therapy Giriş: Bu çalışmanın ana amacı genişlemiş spektrumlu beta-laktamaz üreten Gram-olumsuz basillere bağlı gelişen üriner sistem enfeksiyonlarında ertapenemin ayaktan paranteral antibiyotik tedavisi (APAT) ve hastanede yatan hasta paranteral antibiyotik tedavisi (YPAT) olarak uygulanması arasındaki maliyet farkının değerlendirilmesi ve yakın gelecekte Türkiye'de ertapenemin APAT programına alınmasının uygunluğunun tartışılmasıdır. Gereç ve Yöntem: Üriner sistem enfeksiyonu tanısı ile hastanede yatırılan ve ertapenem tedavisi alan 53 hasta retrospektif olarak değerlendirildi. Ertapenem tedavi maliyeti, YPAT olarak hastane kayıtlarından gerçekleşen maliyetten hesaplandı. Sonrasında aynı antibiyotiğin aynı hastalarda APAT programı şeklinde uygulanımı ile oluşacak tahmini maliyet hesaplandı ve maliyetler karşılaştırıldı. Bulgular: Yatan hasta paranteral antibiyotik tedavisi ve APAT arasındaki maliyet farkı 12.305 (5783 €) olarak hesaplandı. Ayaktan paranteral antibiyotik tedavisi programı tedavi maliyetlerinde yaklaşık %20 azalma sağlayacaktır. Eğer hastalar tedavilerini APAT olarak almış olsalardı tahmini kazanılacak yatak gün sayısı 583 gün olarak hesaplandı. Bu da toplam hospitalizasyon gününün %5'ini oluşturmaktaydı. Sonuç: Türkiye'de ertapenem tedavisinin APAT programı şeklinde uygulanması sağlık harcalamalarında finansal yükü ve hasta yatak gün sayısını azaltacaktır. Anahtar Kelimeler: Ertapenem, genişlemiş spektrumlu beta-laktamaz, üriner sistem enfeksiyonu, tedavi maliyeti, ayaktan paranteral antibiyotik te...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Ertapenem Therapy for Urinary Tract Infections and Assessment of Its Suitability for Outpatient Parenteral Antibiotic Therapy Programme in Turkey

Örmen¹,

Türker²,

Sezak³

et al. 2018

mjima

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“…OPAT has demonstrated costeffectiveness benefits when compared to a full in-hospital IV antibiotic treatment course [2]. A recent analysis of a 334-person cohort in the UK estimated a yearly cost of approximately £300,000 (including pre-clinical set-up costs), whereas the minimum theoretical in-patient cost was more than three times higher at £1,005,676 [3].…”

Section: Abstract R é S U M émentioning

confidence: 99%

PICC Your Battles: Considering the Appropriateness of Peripherally Inserted Central Catheter (PICC) Lines for Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs)

Billick

2017

UOJM

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Les utilisateurs de drogues injectables (UDIs) ayant besoin d'une antibiothérapie par voie parentérale ambulatoire (APA) pour des infections associées aux injections se voient fréquemment refuser l'accès à un cathéter central à insertion périphérique (PICC, de l'anglais) puisqu'on présume qu'ils l'utiliseront pour s'injecter des drogues illicites, et que le cathéter sera utilisé de manière non stérile ou peu hygiénique. Bien que les UDIs présentent des taux plus élevés d'endocardite infectieuse, d'abcès et de septicémie, il n'existe pas de preuves substantielles qui démontrent que les PICCs chez les UDIs entraînent des infections plus sévères, ou une hausse de surdoses, de morbidité ou de mortalité. La transition réussie des UDIs d'un traitement hospitalier vers une APA exige une sélection attentive des patients. Notamment, la situation de logement, les antécédents de santé mentale, la présence d'un système de soutien et la volonté du patient de suivre le traitement contribuent tous au succès de l'APA. Des conversations honnêtes et directes doivent avoir lieu entre le patient et le fournisseur de soins quant aux risques et aux avantages d'un PICC et de l'utilisation de drogues injectables. Un suivi étroit, une approche compatissante, la formation appropriée des fournisseurs de soins, et l'expansion des programmes de répit constituent tous de nouvelles façons de réduire les méfaits et d'améliorer les soins aux patients. Finalement, plus de recherche est nécessaire afin de mettre en place des protocoles, des lignes directrices, des critères de dépistage et des transitions de soins, et pour clarifier les pratiques exemplaires quant à l'APA chez les patients qui utilisent des drogues injectables. BT lay with her head cocked in the only comfortable position, her thin legs protruding below flimsy hospital sheets. I was on a rotation in Infectious Diseases based at several Toronto-area hospitals and she was not my first intravenous (IV) drug-using patient. She was, however, the first patient I had seen who was unable to move her head more than several millimeters in either direction since a paraspinal abscess precariously abutted her spinal cord.BT could be argumentative-she had yelled at several nurses and often refused to have her vital signs taken. She also told me she was scared-she recognized that finding herself in this position was likely secondary to her IV drug use. Despite delivering attentive care, some of the nurses rolled their eyes when talking about Injection drug users (IDUs) requiring outpatient parenteral antibiotic therapy (OPAT) for injection-related infections are regularly denied the use of peripherally inserted central catheter (PICC) lines based on the assumption that they will use the port to inject illicit drugs, and that it will be used in a non-sterile/unclean fashion. While IDUs have higher rates of infective endocarditis, abscesses and septicemia, there is no substantial body of evidence that PICC lines in IDUs result in more serious infections, increased overdoses or increased morbidity o...

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“…[1][2][3] The increasing use of OPAT prompted the first Infectious Diseases Society of America (IDSA) practice guideline for community-based parenteral anti-infective therapy in 1997, which was recently updated in 2004. 4,5 We found no clinical data on the validity or reliability of documenting response to therapy despite many recent published reviews on the topic of SSTIs.…”

Section: Ré Sumémentioning

confidence: 99%

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

Lund

Joo

Lewis

et al. 2013

CJEM

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Objectives: Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections. Methods: A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age $ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (a 5 0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction. Results: Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days, p 5 0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and , 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively).Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED. Conclusions: PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive. RÉ SUMÉObjectif: Les moyens actuels de documentation des infections de la peau et des tissus mous chez les patients soumis à un traitement anti-infectieux parenté ral ambulatoire (TAIPA) comprennent les descriptions é crites et les croquis des tissus infecté s, mais ces moyens peuvent ne pas rendre pleinement l'é tat clinique. Aussi avons-nous mené une é tude visant à dé terminer si la photodocumentation (PD) pouvait amé liorer la duré e du traitement des infections de la peau et des tissus mous chez les patients externes. Mé thode: Un essai prospectif, à ré partition alé atoire, et à simple insu a é té mené au service des urgences d'un hô pital communautaire et d'un centre hospitalier universitaire de soins tertiaires. Ont participé à l'essai des pati...

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Cost Analysis of an Adult Outpatient Parenteral Antibiotic Therapy (OPAT) Programme

Abstract: This analysis supports the premise that an adult OPAT programme can substantially reduce healthcare costs in the Canadian healthcare setting.

Cited by 86 publications

References 9 publications

Cost Analysis of Ertapenem Therapy for Urinary Tract Infections and Assessment of Its Suitability for Outpatient Parenteral Antibiotic Therapy Programme in Turkey

Cost Analysis of Ertapenem Therapy for Urinary Tract Infections and Assessment of Its Suitability for Outpatient Parenteral Antibiotic Therapy Programme in Turkey

PICC Your Battles: Considering the Appropriateness of Peripherally Inserted Central Catheter (PICC) Lines for Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs)

Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial

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