Financial Analysis of Dalbavancin for Acute Bacterial Skin and Skin Structure Infections for Self-Pay Patients

Abstract

Introduction Acute bacterial skin and skin structure infections (ABSSSI) are an increasing cause of admission in the self-pay population. We previously reported that patients with ABSSSI discharged to receive dalbavancin showed a decreased length of stay (LOS) and total direct costs without increasing 30-day readmission rate. For patients who are financially eligible, a dalbavancin vial replacement program can offset costs. The objective of this study was to determine cost differences in treating ABSSSI in self-pay inpatients discharged to receive dalbavancin compared to standard of care (SOC). Methods This retrospective cohort within a community health system compared self-pay adult inpatients with ABSSSI from February 3, 2016 to August 5, 2019 discharged to receive dalbavancin at an outpatient infusion center with SOC intravenous antibiotics. Patients were included with cellulitis, abscess, or postoperative wound infections diagnoses on the basis of International Classification of Disease, Tenth Revision (ICD-10) codes. Excluded populations were patients without dalbavancin vial replacement performed, pregnant, infections caused exclusively by gram-negative bacteria or fungi, or ICD-10 codes not consistent with ABSSSI. The primary outcome was direct cost of hospital stay. Secondary outcomes included length of stay (LOS), 30-day readmission rates, adverse events (AE), and indirect hospital costs. On the basis of previous studies, a one-sided Student’s t test was performed on financial data. Results Twelve dalbavancin and 263 SOC patients met inclusion criteria. Direct cost ($2758 vs $4010, p = 0.105) and indirect hospital cost ($2913 vs $3646 , p = 0.162) per patient were less in the dalbavancin group. There was no significant difference between median LOS (4 vs 4, p = 0.888), AE (0% vs 14.8%), and 30-day readmission rates for dalbavancin vs SOC group (8.3% vs 7.2%, p = 0.604). Conclusion Self-pay patients with ABSSSI discharged to receive dalbavancin with vial replacement resulted in decreased direct and indirect costs per patient with similar 30-day readmission rates, AE, and LOS. More studies targeted toward this population are warranted to determine ultimate benefit.

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

“…In addition, the majority of patients in this study were uninsured with limited or no consistent source of income. Of note, reimbursement for LaLGPs varies based on site of administration (i.e., inpatient versus outpatient) [ 9 ]. A stewardship-led initiative at our institution to assist in transitions of care for patients receiving LaLGPs includes the proactive use of a patient assistance program (PAP) available from the manufacturer (AbbVie Inc. ® , North Chicago, IL, USA), where medication vials may be sent directly from the company at no cost for qualifying patients [ 19 ].…”

“…There are limited data examining clinical outcomes and cost savings in patients with osteomyelitis and infective endocarditis who received LaLGPs [ 5 , 6 , 7 , 8 , 9 ]. Although these data are encouraging, the studies are often descriptive in nature, limited to a single hospital, or focused on ABSSSI as an indication.…”

Dalbavancin in real life: Economic impact of prescription timing in French hospitals

“…Moreover, potential health risks associated with prolonged hospitalization should be taken into account, as well as the improvement in the quality of life related to early discharge. Beyond the hospital perspective, a small study also suggested decreased direct and indirect costs for self-pay (i.e., uninsured, usually with a low income) patients with ABSSSIs who were switched to dalbavancin after discharge [18].…”

“…Most economic studies have extrapolated the reduction in the LoS observed in real-life studies compared to usual treatments to a reduction in hospitalization-related costs from a societal perspective [15][16][17]. A budget impact analysis of dalbavancin use in a small series of twelve self-pay patients treated for ABSSSIs [18] was carried out, but its specific context (self-pay patients in the USA) made it hardly extrapolatable. To date, no comparison between dalbavancin and standard of care in real patients has been carried out with an economic analysis on the impact on the LoS.…”

Dalbavancin for the Treatment of Prosthetic Joint Infections: A Narrative Review

“…Several other reports position DAL as a cost-saving alternative [55,56], although, in a recent study, the results of González et al pointed in the opposite direction [57], finding DAL to be more expensive than the standard of care for the treatment of skin and soft tissue infections. Nevertheless, in the same journal, Bookstaver et al replied with more specific considerations other than cost and calling for other issues to be taken into account when thinking about antimicrobial stewardship [58].…”