Cost Perspectives for Outpatient Intravenous Antimicrobial Therapy

Abstract

Intravenous antimicrobial therapy often continues after a patient is discharged from the hospital or it begins in the outpatient setting. Reimbursement for this therapy varies by payer. The United States Outpatient Parenteral Antibiotic Therapy (OPAT) Outcomes Registry is a valuable resource for quantifying cost by payer, as well as for describing practice patterns and adverse events related to intravenous antimicrobial therapy. To describe the reimbursement structure and cost of intravenous vancomycin home care therapy for four different types of payers, a survey of home infusion companies was done. Also surveyed were infusion programs participating in the OPAT Outcomes Registry, representing four different types of payers, to determine the cost of outpatient intravenous therapy. A retrospective cohort study of these infusion programs was conducted to describe practice patterns and to identify adverse events that resulted from intravenous vancomycin. We found that the cost of outpatient therapy was substantial, although nonuniform, across payer types. Alternative outpatient therapies associated with lower risks for adverse events and lower costs should be considered.

An economic evaluation of a European cohort from a multinational trial of linezolid versus teicoplanin in serious Gram-positive bacterial infections: the importance of treatment setting in evaluating treatment effects

“…It is worth pointing out that treatment in OHPAT could still incur substantial cost that was underestimated in this trial [35,36]. These results support the findings from earlier studies comparing linezolid with vancomycin, which show that the oral formulation of linezolid can facilitate early hospital discharge [17,19,22] and shorten LOS [20].…”

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy

“…Since the 1997 OPAT guidelines were published, some progress has been made in defining the appropriate outcomes to monitor and the techniques for their measurement; however, available data are sparse and rarely prospective [74,75,77,[129][130][131][132][133][134][135][136][137][138]. The articles referenced in the Appendix support the effectiveness of OPAT for many indications [11].…”

“…Limited data are available to allow for comparison of a program's performance with a national database for benchmarking purposes. The OPAT Outcomes Registry is a national database [135,136,147] that is accumulating data that can help compare a program's performance with that of an aggregate of 130 centers with over 14,000 cases [147][148][149]. An OPAT center collects data on outcomes for the patients and can monitor its own clinical performance over time.…”

“…This is particularly useful in the absence of published outcomes standards for infections treated with OPAT. Parameters which are monitored in the OPAT Outcomes Registry are listed in table 8 [136,147]. Patient safety and health care-related infections are of particular concern with OPAT.…”

How much money can be saved by applying intravenous antibiotics once instead of several times a day?

“…Once instead of three or four times daily administration has potential benefits in addition to save nursing staff time, such as, most importantly, earlier discharge, which may further significantly reduce the costs for the health care system [6,7] and a reduction of errors and omitted doses. In fact, recent studies found that 22-31% of doses were inappropriately prepared and 19-49% of doses were inappropriately administered [8,9].…”