title: Modeling economic implications of alternative treatment strategies for acute bacterial skin and skin structure infections.
abstract: OBJECTIVE
  The economic implications from the US Medicare perspective of adopting alternative treatment strategies for acute bacterial skin and skin structure infections (ABSSSIs) are substantial. The objective of this study is to describe a modeling framework that explores the impact of decisions related to both the location of care and switching to different antibiotics at discharge.
  
  
  METHODS
  A discrete event simulation (DES) was developed to model the treatment pathway of each patient through various locations (emergency department [ED], inpatient, and outpatient) and the treatments prescribed (empiric antibiotic, switching to a different antibiotic at discharge, or a second antibiotic). Costs are reported in 2012 USD.
  
  
  RESULTS
  The mean number of days on antibiotic in a cohort assigned to a full course of vancomycin was 11.2 days, with 64% of the treatment course being administered in the outpatient setting. Mean total costs per patient were $8671, with inpatient care accounting for 58% of the costs accrued. The majority of outpatient costs were associated with parenteral administration rather than drug acquisition or monitoring. Scenarios modifying the treatment pathway to increase the proportion of patients receiving the first dose in the ED, and then managing them in the outpatient setting or prescribing an oral antibiotic at discharge to avoid the cost associated with administering parenteral therapy, therefore have a major impact and lower the typical cost per patient by 11-20%. Since vancomycin is commonly used as empiric therapy in clinical practice, based on these analyses, a shift in treatment practice could result in substantial savings from the Medicare perspective.
  
  
  CONCLUSIONS
  The choice of antibiotic and location of care influence the costs and resource use associated with the management of ABSSSIs. The DES framework presented here can provide insight into the potential economic implications of decisions that modify the treatment pathway.
authors.affiliation: Evidera , London , UK.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Revankar
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Ward
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Pelligra
authors.forename: Thitima
authors.initials: T
authors.lastname: Kongnakorn
authors.forename: Weihong
authors.initials: W
authors.lastname: Fan
authors.forename: Kenneth T
authors.initials: KT
authors.lastname: LaPensee
mesh_terms: D000081:Acetamides / Q000191:economics / Q000627:therapeutic use; D000208:Acute Disease; D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D017576:Daptomycin / Q000191:economics / Q000627:therapeutic use; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D000069349:Linezolid; D023303:Oxazolidinones / Q000191:economics / Q000627:therapeutic use; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D014481:United States; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D014640:Vancomycin; D000069349:Linezolid; D017576:Daptomycin
keywords: Acute bacterial skin and skin structure infections; Discrete event simulation; Location of care; MRSA; Medicare; Outpatient parenteral antimicrobial therapy