title: Economic Impact of Oritavancin for the Treatment of Acute Bacterial Skin and Skin Structure Infections in the Emergency Department or Observation Setting: Cost Savings Associated with Avoidable Hospitalizations.
abstract: OBJECTIVE
  Data indicate that acute bacterial skin and skin structure infection (ABSSSI) patients without major comorbidities can be managed effectively in the outpatient setting. Because most patients with ABSSSIs present to the emergency department, it is essential that clinicians identify candidates for outpatient treatment given the substantially higher costs associated with inpatient care. We examined the potential cost avoidance associated with shifting care from inpatient treatment with vancomycin to outpatient treatment with oritavancin for ABSSSI patients without major complications or comorbidities.
  
  
  METHODS
  A decision analytic, cost-minimization model was developed to compare costs of inpatient vancomycin versus outpatient oritavancin treatment of ABSSSI patients with few or no comorbidities (Charlson Comorbidity Index score ≤1) and no life-threatening conditions presenting to emergency department. Hospital discharge data from the Premier Research Database was used to determine the costs associated with inpatient vancomycin treatment.
  
  
  RESULTS
  Mean costs for inpatient treatment with vancomycin ranged from $5973 to $9885, depending on Charlson Comorbidity Index score and presence of systemic symptoms. Switching an individual patient from inpatient vancomycin treatment to outpatient oritavancin treatment was estimated to save $1752.46 to $6475.87 per patient, depending on Charlson Comorbidity Index score, presence of systemic symptoms, and use of observation status. Assuming some patients may be admitted to the hospital after treatment with oritavancin, it is estimated that up to 38.12% of patients could be admitted while maintaining budget neutrality.
  
  
  CONCLUSIONS
  This cost-minimization model indicates that use of oritavancin in the emergency department or observation setting is associated with substantial cost savings compared with inpatient treatment with vancomycin.
authors.affiliation: Albany College of Pharmacy and Health Sciences, Albany, New York. Electronic address: thomas.lodise@acphs.edu.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Lodise
authors.affiliation: The Medicines Company, Parsippany, New Jersey.
authors.forename: Weihong
authors.initials: W
authors.lastname: Fan
authors.affiliation: The Medicines Company, Parsippany, New Jersey.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sulham
mesh_terms: D000208:Acute Disease; D000553:Ambulatory Care / Q000191:economics; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D017046:Cost Savings; D003663:Decision Trees; D004636:Emergency Service, Hospital / Q000191:economics; D006020:Glycopeptides / Q000191:economics* / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D000077427:Lipoglycopeptides; D018803:Models, Economic; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000191:economics*; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use / Q000031:analogs & derivatives
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D000077427:Lipoglycopeptides; D014640:Vancomycin; C100708:oritavancin
keywords: ABSSSI; Acute Bacterial Skin and Skin Structure; Infections; oritavancin vancomycin cost impact