title: Identification of Patient Characteristics Influencing Setting of Care Decisions for Patients With Acute Bacterial Skin and Skin Structure Infections: Results of a Discrete Choice Experiment.
abstract: OBJECTIVE
  Rates of acute bacterial skin and skin structure infections (ABSSSI) have sharply increased since 2000. Treatment may be administered in the inpatient or outpatient setting; clinical decision-making regarding hospitalization is inconsistent, often leading to hospitalization of some patients with ABSSSI who qualify for outpatient parenteral antimicrobial therapy, which leads to increased overall care costs. New antibiotics such as oritavancin are hypothesized to be a cost-effective option improving accessibility to ambulatory treatment of ABSSSI. The goal of this study was to understand the patient attributes that affect clinical decision-making regarding the setting of care for ABSSSI treatment.
  
  
  METHODS
  An observational, cross-sectional study was conducted that surveyed clinicians of various specialties from the United States and the United Kingdom. The survey collected quantitative responses and used a series of choice-based experimental designs to evaluate patient attributes influencing clinical treatment decisions.
  
  
  RESULTS
  Infection severity, severe comorbidities, and age ≥ 75 years were observed to have the greatest impact on treatment location decisions (odds ratio [OR], 0.000-0.004 [95% CI, 0.000-0.011], vs mild ABSSSI; OR, 0.246-0.484 [95% CI, 0.154-0.788], vs no active comorbidities; OR, 0.136-0.523 [95% CI, 0.070-0.888], vs ≤ 18 years, respectively). The majority of respondents indicated they would consider oritavancin to avoid postdischarge outpatient parenteral antimicrobial therapy or oral therapy, regardless of the pathogen (63.5%-83.5%).
  
  
  CONCLUSIONS
  Key factors influencing ABSSSI treatment setting were severity of infection, severity of comorbidities, and age. Clinicians surveyed identified patient profiles in which single-dose oritavancin might enable wholly outpatient or shortened inpatient management. Additional studies to elucidate the ABSSSI care pathways that include oritavancin and other novel antibiotics are needed.
authors.affiliation: ICON plc Epidemiology, Vancouver, British Columbia, Canada. Electronic address: suzanne.lane@iconplc.com.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lane
authors.affiliation: ICON plc Epidemiology, Vancouver, British Columbia, Canada.
authors.forename: Karissa
authors.initials: K
authors.lastname: Johnston
authors.affiliation: The Medicines Company, Waltham, Massachusetts.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sulham
authors.affiliation: ICON plc Epidemiology, Vancouver, British Columbia, Canada.
authors.forename: Iqra
authors.initials: I
authors.lastname: Syed
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thomas
authors.initials: T
authors.lastname: Holland
authors.affiliation: Ninewells Hospital and Medical School, Dundee, United Kingdom.
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
mesh_terms: D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000191:economics*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000066491:Clinical Decision-Making; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006020:Glycopeptides / Q000008:administration & dosage*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D000077427:Lipoglycopeptides; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000191:economics; D006113:United Kingdom; D014481:United States; D014640:Vancomycin / Q000031:analogs & derivatives
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D000077427:Lipoglycopeptides; C100708:oritavancin; D014640:Vancomycin
keywords: ABSSSI; attributes; decision-making; outpatient