title: False economies in home-based parenteral antibiotic treatment: a health-economic case study of management of lower-limb cellulitis in Australia.
abstract: OBJECTIVE
  The majority of healthcare costs accrued managing cellulitis can be attributed to the small proportion of patients treated with parenteral antibiotics. Hospital in the home (HITH) instead of or following initial inpatient treatment is a safe and effective alternative, but there are few data evaluating its cost-effectiveness for cellulitis.
  
  
  METHODS
  Our retrospective cohort study included all treatment episodes (by either HITH or an inpatient service for >24 h) with an ICD-10 primary diagnosis code of lower-leg cellulitis at a tertiary-level health service in Melbourne, Australia over 12 months (2012-13). Data included demography, social factors and ICD-10 codes mapped to major comorbidities constituting the Charlson comorbidity index (CCI). Differences in length of stay (LOS) and individual clinical costing (ICC) between HITH- and non-HITH-treated patients were tested with univariable and multivariable (generalized linear model) analyses.
  
  
  RESULTS
  For 328 admissions in 294 patients, the average per-day costs were AU$431 for HITH and AU$761 for inpatient care. For 124 patients (38%) treated in HITH, both LOS [mean (95% CI) 7.48 days (6.76-8.20 days) versus 5.82 days (3.45-8.18 days)] and ICC [mean (95% CI) AU$5873 (AU$5212-AU$6534) versus AU$5196 (AU$4567- AU$5824)] were higher than those for patients with solely inpatient care. In multivariable analysis controlling for age, comorbidity, carer support and language, HITH remained associated with significantly longer LOS [1.63-fold (95% CI: 1.24- to 2.13-fold): P < 0.001] and non-significantly with higher cost [1.14-fold (95% CI: 0.97- to 1.34-fold): P = 0.11].
  
  
  CONCLUSIONS
  Management of cellulitis represents a substantial cost burden for hospital services. Modest per-day cost savings from HITH can be offset by much longer HITH LOS.
authors.affiliation: Western Health, Gordon Street, Footscray, VIC 3011, Australia.
authors.forename: Kamya
authors.initials: K
authors.lastname: Kameshwar
authors.affiliation: Western Health, Gordon Street, Footscray, VIC 3011, Australia Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, The University of Melbourne, VIC 3010, Australia.
authors.forename: Amalia
authors.initials: A
authors.lastname: Karahalios
authors.affiliation: Western Health, Gordon Street, Footscray, VIC 3011, Australia North West Academic Centre, The University of Melbourne, VIC 3010, Australia.
authors.forename: Edward
authors.initials: E
authors.lastname: Janus
authors.affiliation: Western Health, Gordon Street, Footscray, VIC 3011, Australia North West Academic Centre, The University of Melbourne, VIC 3010, Australia The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade Parkville, VIC 3052, Australia harin.karunajeewa@wh.org.au.
authors.forename: Harin
authors.initials: H
authors.lastname: Karunajeewa
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001315:Australia; D002481:Cellulitis / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents