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Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain

https://doi.org/10.1016/j.ijantimicag.2017.02.017Get rights and content

Highlights

  • OPAT is an alternative to hospitalisation for serious infections in clinically stable patients.

  • Hospital at Home (HaH)-administered OPAT was safe and clinically effective.

  • HaH-administered OPAT costs ca. 80% less than inpatient care.

Abstract

The aim of this study was to assess the direct healthcare costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home (HaH) units in Spain. An observational, multicentre, economic evaluation of retrospective cohorts was conducted. Patients were treated at home by the HaH units of three Spanish hospitals between January 2012 and December 2013. From the cost accounting of HaH OPAT (staff, pharmacy, transportation, diagnostic tests and structural), the cost of each outpatient course was obtained following a top-down strategy based on the use of resources. Costs associated with inpatient stay, if any, were estimated based on length of stay and ICD-9-CM diagnosis. There were 1324 HaH episodes in 1190 patients (median age 70 years). The median (interquartile range) stay at home was 10 days (7–15 days). Of the OPAT episodes, 91.5% resulted in cure or improvement on completion of intravenous therapy. The mean total cost of each infectious episode was €6707 [95% confidence interval (CI) €6189–7406]. The mean cost per OPAT episode was €1356 (95% CI €1247–1560), mainly distributed between healthcare staff costs (46%) and pharmacy costs (39%). The mean cost of inpatient hospitalisation of an infectious episode was €4357 (95% CI €3947–4977). The cost per day of inpatient hospitalisation was €519, whilst the cost per day of OPAT was €98, meaning a saving of 81%. This study shows that OPAT administered by HaH units resulted in lower costs compared with inpatient care in Spain.

Introduction

According to the Spanish Ministry of Health, in 2013 there were at least 390,000 hospital admissions with diagnoses related to infectious diseases, with a total cost of more than €1600 million [1]. Most patients admitted with infections receive intravenous (i.v.) antibiotic treatment, and an unknown number remain hospitalised only to complete parenteral treatment.

Outpatient parenteral antimicrobial therapy (OPAT) is being increasingly used worldwide [2]. The rationale for OPAT is that it increases the availability of hospital beds by reducing or avoiding hospital stays [3] and by releasing beds blocked by patients with multidrug-resistant infections [4].

Hospital at Home (HaH), which provides hospital-level care at home to patients who would otherwise remain hospitalised, is a suitable care model for OPAT [5]. In Spain, HaH is hospital-based and consists of specifically dedicated physicians and nurses who monitor patients daily and make home visits [6], including patients with greater severity and dependence and those in the acute phase of the disease process [7]. The first HaH unit was established in the Gregorio Marañón Hospital (Madrid, Spain), followed by the gradual introduction of other units in the rest of the country, including the Hospital of Torrejón and the Sabadell Hospital. These three HaH units have more than 5 years of experience. Nowadays, these three hospitals have more than 250 inpatient beds. Although the three units share a similar care model, there are differences in the frequency of visits, the proportion of physicians/nurses and family involvement in the administration of i.v. treatment. To determine the efficacy of the OPAT model in Spain and to broaden its use, these three hospitals created a database (OPAT registry) [8]. This registry was set up to prospectively register patient characteristics, antimicrobial treatment and clinical outcomes. Previous to this study, there was an evaluation of the efficacy and safety of OPAT in the Spanish HaH model [8]. However, Spanish economic studies on the use of HaH for OPAT are lacking.

The objective of this study was to perform an economic analysis of OPAT administered and monitored by HaH units, including costs and the estimated savings compared with conventional hospitalisation.

Section snippets

Study design and population

An observational, multicentre, economic evaluation of retrospective cohorts was performed. Patients were treated at home by the OPAT units of three Spanish university hospitals (Hospital Gregorio Marañón, Hospital of Torrejón and Sabadell Hospital) during 2012 and 2013.

Patients meeting the following defined criteria were enrolled into the OPAT service: diagnostic certainty of infection; requirement for i.v. antimicrobials; adequate venous access; and appropriate level of understanding and

Patient characteristics and clinical outcomes

During the 2-year study period, 1324 admissions to HaH units for OPAT due to infections in 1190 patients were recorded. Most patients were male (58.9%), with a median age of 70 years (IQR, 54.2–79.1 years). The Charlson comorbidity index was ≥4 in 21.8% of cases. The most frequent types of infection were complicated urinary tract infections (29.8%), respiratory infections (23.2%) and intra-abdominal infections (19.9%).

The median stay attributable to the full infectious process was 15 days (IQR,

Discussion

The main objective of this study was to determine the mean cost of OPAT administered by HaH units in Spain according to the cost accounting of the three study centres. Unlike other studies, the cost incurred during hospitalisation prior to HaH admission was taken into account. Therefore, we were able to estimate the cost of the complete infectious process. A notable difference was found between the cost per day of hospitalisation and that of HaH. In a time of financial constraints, OPAT has

Acknowledgments

The authors thank Nuria Puig and Rafael Cavanillas (Merck & Co.) for reviewing and revising the manuscript.

Funding: The economic analysis in this study was sponsored by Merck & Co., Inc.

Competing interests: MM-R has received speaker fees from Boehringer Ingelheim, Merck Sharp & Dohme, Novartis and Aldo-Unión; VJGR has received speaker fees from Novartis and Merck Sharp & Dohme; AM has received speaker fees from Merck Sharp & Dohme and Boehringer Ingelheim; OE has received speaker fees from

References (20)

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On behalf of Grupo de Trabajo de Hospitalización a Domicilio y Telemedicina de la Sociedad Española de Medicina Interna.

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