title: How is income generated by outpatient parenteral antibiotic treatment (OPAT) in the UK? Analysis of payment tariffs for cellulitis.
abstract: OBJECTIVE
  We determined the available mechanisms to generate income from outpatient parenteral antimicrobial therapy (OPAT) in the UK and calculated the revenue generated from treatment of an episode of cellulitis.
  
  
  METHODS
  Revenue was calculated for patients receiving treatment for cellulitis as an inpatient and for patients receiving OPAT by a series of different payment pathways. Selected established OPAT services in Northern Ireland, Scotland and Wales, where Payment-by-Results (PbR) does not operate, were contacted to determine individual national funding arrangements.
  
  
  RESULTS
  In England, a traditional inpatient episode for uncomplicated cellulitis requiring 7 days of treatment generated £1361 of revenue, while OPAT generated revenue ranging from £773 to £2084 for the same length of treatment depending on the payment pathway used. Treatment using OPAT to avoid admission entirely generated £2084, inpatient admission followed by transfer to a virtual OPAT ward at day 2 generated £1361 and inpatient admission followed by discharge from hospital to OPAT at day 2 generated £773. In Northern Ireland, Scotland and Wales block contracts were used and no income was calculable for an individual episode of cellulitis.
  
  
  CONCLUSIONS
  No single funding mechanism supports OPAT across the UK. In England, revenue generated by OPAT providers from treatment of cellulitis varied with the OPAT payment pathway used, but equalled or exceeded the income generated from equivalent inpatient care. Cost savings for OPAT and reuse of released inpatient beds will increase revenue further. A single OPAT tariff is proposed.
authors.affiliation: Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
authors.forename: G R
authors.initials: GR
authors.lastname: Jones
authors.affiliation: Department of Pharmacy, Isle of Wight NHS Trust, St Mary's Hospital, Newport, Isle of Wight PO30 5TG, UK debbie.cumming@iow.nhs.uk.
authors.forename: D V E
authors.initials: DV
authors.lastname: Cumming
authors.affiliation: Department of Pharmacy, Isle of Wight NHS Trust, St Mary's Hospital, Newport, Isle of Wight PO30 5TG, UK.
authors.forename: G
authors.initials: G
authors.lastname: Honeywell
authors.affiliation: Hospital and Ambulance Directorate, Isle of Wight NHS Trust, St Mary's Hospital, Newport, Isle of Wight PO30 5TG, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ball
authors.affiliation: Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: F
authors.initials: F
authors.lastname: Sanderson
authors.affiliation: Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0NA, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Seaton
authors.affiliation: University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK Public Health Wales (Microbiology), Cardiff, UK.
authors.forename: B
authors.initials: B
authors.lastname: Healy
authors.affiliation: The Royal Hospitals, Grosvenor Road, Belfast BT12 6BA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hedderwick
authors.affiliation: Department of Infection, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK Department of Infection and Pharmacy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gilchrist
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000188:drug therapy*; D005249:Fees and Charges; D005381:Financing, Organized; D006801:Humans; D007263:Infusions, Parenteral; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents
keywords: OPAT; finance; home intravenous antibiotics