title: Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting.
abstract: OBJECTIVE
  To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission.
  
  
  METHODS
  Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$.
  
  
  RESULTS
  Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications).
  
  
  CONCLUSIONS
  Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy.
  
  
  CONCLUSIONS
  Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.
authors.affiliation: a Pharmerit International , Bethesda , MD , USA.
authors.forename: V
authors.initials: V
authors.lastname: Ektare
authors.affiliation: a Pharmerit International , Bethesda , MD , USA.
authors.forename: A
authors.initials: A
authors.lastname: Khachatryan
authors.affiliation: a Pharmerit International , Bethesda , MD , USA.
authors.forename: M
authors.initials: M
authors.lastname: Xue
authors.affiliation: b Durata Therapeutics , Chicago , IL , USA.
authors.forename: M
authors.initials: M
authors.lastname: Dunne
authors.affiliation: b Durata Therapeutics , Chicago , IL , USA.
authors.forename: K
authors.initials: K
authors.lastname: Johnson
authors.affiliation: a Pharmerit International , Bethesda , MD , USA.
authors.forename: J
authors.initials: J
authors.lastname: Stephens
mesh_terms: D061605:Administration, Intravenous / Q000191:economics / Q000379:methods; D000553:Ambulatory Care / Q000191:economics*; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003663:Decision Trees; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000191:economics; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D055624:Methicillin-Resistant Staphylococcus aureus; D018803:Models, Economic; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000191:economics*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000191:economics; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Avoidable admission; Cost; Economics; Length of stay; MRSA