Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-18T08:47:23.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost minimization analysis of outpatient parenteral/oral antibiotic therapy at a trauma hospital: Public health system

Published online by Cambridge University Press:  23 February 2021

Gustavo Henrique Loesch ,
June Alisson Westarb Cruz ,
Juliano Gasparetto ,
Dayana dos Santos Oliveira ,
Joao Paulo Telles  and
Felipe Francisco Tuon Open the ORCID record for Felipe Francisco Tuon [Opens in a new window]
Gustavo Henrique Loesch
Affiliation:
Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
June Alisson Westarb Cruz
Affiliation:
Business School, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
Juliano Gasparetto
Affiliation:
Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
Dayana dos Santos Oliveira
Affiliation:
Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
Joao Paulo Telles
Affiliation:
Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
Felipe Francisco Tuon*
Affiliation:
Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
*
Author for correspondence: Felipe F. Tuon, E-mail: felipe.tuon@pucpr.br
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the impact of outpatient parenteral antimicrobial therapy (OPAT) on a public hospital in a middle-income country.

Design:

A retrospective, observational study analyzing the economic data retrieved on the dehospitalization of patients on antibiotic therapy.

Setting:

Public university trauma hospital.

Patients:

Data were collected from June 2017 to May 2020. Antibiotic cost, hospital length of stay, and risk of multidrug-resistant (MDR) infection or colonization were reviewed, along with the break-even point at which a balance occurs between OPAT antimicrobial costs and all in-hospital costs. A cumulative risk curve was constructed showing the incidence of MDR during the review period.

Results:

In total, 225 patients were studied. The implementation of OPAT resulted in a reduction of $156,681 (49.6%), which is equivalent to an average of $696 per patient, as well as a shortened length of stay, from 33.5 to 15.7 days. OPAT reduces the risk of acquiring infection by MDR bacteria by having the final treatments administered outside of the hospital environment. The breakeven curves, comparing the duration of the OPAT to daily medication costs, allowed for the prediction of the time and dollar costs of antibiotic therapy.

Conclusions:

OPAT presented a significant cost savings, shortened length of stay, and reduced risk of contamination of patients by MDR.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 12 , December 2021 , pp. 1445 - 1450
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chapman AL Outpatient parenteral antimicrobial therapy. BMJ 2013;346:f1585.CrossRefGoogle Scholar
Rucker, RW, Harrison, GM. Outpatient intravenous medications in the management of cystic fibrosis. Pediatrics 1974;54:358–360.CrossRefGoogle ScholarPubMed
Corwin, P, Toop, L, McGeoch, G, et al. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital. BMJ 2005;330:129.CrossRefGoogle ScholarPubMed
Bernard, L, El, H, Pron, B, et al. Outpatient parenteral antimicrobial therapy (OPAT) for the treatment of osteomyelitis: evaluation of efficacy, tolerance and cost. J Clin Pharm Ther 2001;26:445–451.CrossRefGoogle ScholarPubMed
Amodeo, MR, Clulow, T, Lainchbury, J, et al. Outpatient intravenous treatment for infective endocarditis: safety, effectiveness and one-year outcomes. J Infect 2009;59:387–393.CrossRefGoogle ScholarPubMed
Bazaz, R, Chapman, AL, Winstanley, TG. Ertapenem administered as outpatient parenteral antibiotic therapy for urinary tract infections caused by extended-spectrum-beta-lactamase-producing gram-negative organisms. J Antimicrob Chemother 2010;65:1510–1513.CrossRefGoogle ScholarPubMed
Carratala, J, Fernandez-Sabe, N, Ortega, L, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med 2005;142:165–172.CrossRefGoogle ScholarPubMed
Tice, AD, Strait, K, Ramey, R, Hoaglund, PA. Outpatient parenteral antimicrobial therapy for central nervous system infections. Clin Infect Dis 1999;29:1394–1399.CrossRefGoogle ScholarPubMed
Teuffel, O, Ethier, MC, Alibhai, SM, Beyene, J, Sung L Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol 2011;22:2358–2365.CrossRefGoogle ScholarPubMed
Esposito, S, Leone, S, Noviello, S, et al. Outpatient parenteral antibiotic therapy in the elderly: an Italian observational multicenter study. J Chemother 2009;21:193–198.CrossRefGoogle ScholarPubMed
Zequinao, T, Gasparetto, J, Oliveira, DDS, Silva, GT, Telles, JP, Tuon, FF. A broad-spectrum beta-lactam–sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles. Braz J Infect Dis 2020;24:221–230.CrossRefGoogle Scholar
Oliveira, PR, Carvalho, VC, Cimerman, S, Lima, ALM, Diretrizes Brasileiras para Terapia Antimicrobiana Parenteral Ambulatorial Group. Recommendations for outpatient parenteral antimicrobial therapy in Brazil. Braz J Infect Dis 2017;21:648–655.CrossRefGoogle ScholarPubMed
Tice, AD, Rehm, SJ, Dalovisio, JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. IDSA guidelines. Clin Infect Dis 2004;38:1651–1672.CrossRefGoogle ScholarPubMed
Zhou, Q, Fan, L, Lai, X, Tan, L, Zhang, X. Estimating extra length of stay and risk factors of mortality attributable to healthcare-associated infection at a Chinese university hospital: a multistate model. BMC Infect Dis 2019;19:975.CrossRefGoogle Scholar
Heintz, BH, Halilovic, J, Christensen, CL. Impact of a multidisciplinary team review of potential outpatient parenteral antimicrobial therapy prior to discharge from an academic medical center. Ann Pharmacother 2011;45:1329–1337.CrossRefGoogle ScholarPubMed
Shah, PJ, Bergman, SJ, Graham, DR, Glenn, S. Monitoring of outpatient parenteral antimicrobial therapy and implementation of clinical pharmacy services at a community hospital infusion unit. J Pharm Pract 2015;28:462–468.CrossRefGoogle Scholar
Bittencourt, RJ, Hortale, VA. Interventions to solve overcrowding in hospital emergency services: a systematic review. Cad Saude Publica 2009;25:1439–1454.CrossRefGoogle ScholarPubMed