Economic Burden of Home Antimicrobial Therapy: OPAT Versus Oral Therapy

Abstract

BACKGROUND: There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. Our objective was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL). METHODS: We conducted a prospective cohort study of caregivers for children after hospitalization who were treated with prolonged antimicrobial therapy. We collected data about missed work and school and time spent administering therapy. Caregivers completed the Pediatric Quality of Life Inventory to assess QoL. Clinical information included length of stay, treatment indication, and type of therapy (OPAT versus oral therapy). Direct medical costs were obtained by using a microcosting system and accounted for medication, supplies, and homenursing visits. The primary cost outcome was the mean daily cost of therapy. Multivariable models were developed to adjust for potential confounders. RESULTS: Two hundred and twelve caregivers completed surveys: 123 (58%) for oral therapy and 89 (42%) for OPAT. Caregivers administering OPAT reported more missed work, missed school for their children, time with daily medication administration (90 vs 6 minutes; P , .01) and lower QoL scores (77.8 vs 68.9

To Discharge or Not to Discharge on Outpatient Parenteral Antimicrobial Therapy: That Is the Question

“…The overuse of OPAT demonstrates a clear need for further health outcomes research in children. Although previous studies have established the safety and cost-effectiveness of OPAT, the current study by Krah et al 14 highlights the potentially negative patient and caregiver experiences associated with pediatric OPAT. While we await additional health outcomes research studies, hospitalists should continue to collaborate with ID-trained physicians to minimize unnecessary OPAT and optimize oral antibiotics when appropriate.…”

“…findings reported by Krah et al 14 are an important reminder to OPAT prescribers that the direct and indirect costs of the outpatient administration of IV therapy must be considered at the point of prescribing.…”

Recent Updates in Antimicrobial Stewardship in Outpatient Parenteral Antimicrobial Therapy

“…Beyond the minimization of line placement and healthcare exposure, COpAT is accompanied by other significant benefits. A study of pediatric patients comparing economic and patient-related benefits of those receiving COpAT with those receiving OPAT found COpAT was associated with significantly lower direct costs of therapy, less missed school for children, less missed work for caregivers, a higher level of caregiver comfort with the planned regimen, and better caregiver quality of life [ 11 ]. Multiple studies have evaluated the impact of the use of oral antimicrobials or implementation of protocols allowing for the use of oral antibiotics in the treatment of bone and joint infections [ 12 •, 13 ].…”

Trends in Use of Postdischarge Intravenous Antibiotic Therapy for Children

“…Line infections, clots, mechanical problems, and general discomfort complicate PICCs, which led to their removal in more than 20% of children in one study 1 . Oral antibiotics avoid these complications and are less burdensome to families 2 . Recently, a series of multicenter studies showed no difference in outcomes between oral and postdischarge intravenous antibiotic therapy (PD‐IV) for complicated appendicitis, osteomyelitis, and complicated pneumonia 3‐5 …”

“…1 Oral antibiotics avoid these complications and are less burdensome to families. 2 Recently, a series of multicenter studies showed no difference in outcomes between oral and postdischarge intravenous antibiotic therapy (PD-IV) for complicated appendicitis, osteomyelitis, and complicated pneumonia. [3][4][5] Despite a growing body of evidence suggesting that oral therapy ought to be the default treatment strategy rather than PD-IV, the extent to which practices have changed is unknown.…”