Use of Oritavancin in Acute Bacterial Skin and Skin Structure Infections Patients Receiving Intravenous Antibiotics: A US Hospital Budget Impact Analysis

Abstract

Background and objective: Nearly 10% of all US hospital admissions are attributed to acute bacterial skin and skin structure infections (ABSSSIs). While most antibacterials used to treat these infections require multi-day and multi-dose regimens, a single-dose treatment is now available. The objective of this analysis is to estimate the annual budget impact of using single-dose oritavancin in patients with moderate to severe ABSSSIs receiving intravenous methicillin-resistant Staphylococcus aureus (MRSA)-active antibacterials from a US hospital perspective.

Methods: A decision-analytic model based on current clinical practice was developed to estimate the economic impact of oritavancin. Utilization of antibacterials and rates of hospital admission were derived from the Premier Research Database. Demographic and clinical data were informed by the published literature and 2014 wholesale drug acquisition costs were used. Other costs were based on the published literature and Medicare National Limitation amounts. All costs were inflated to 2014 US dollars. Two base-case scenarios were considered: one for hospitals with ambulatory services and one for hospitals without ambulatory services.

Results: For a US hospital with ambulatory services with 1000 ABSSSI patients receiving intravenous MRSA antibiotics annually, use of oritavancin in 26% of patients is estimated to reduce the total annual budget by 12.9% (US$1.23 million), or approximately US$1234.67 per patient. Total inpatient costs will be reduced by 22.3% (US$1.40 million) and outpatient costs will increase slightly by 1.7% (US$55,310). Pharmaceutical cost increases are offset by savings in the inpatient setting from fewer hospital admissions. Hospitals without ambulatory services are estimated to receive overall cost savings of 9.3% (US$0.63 million).

Conclusion: Use of single-dose oritavancin in select ABSSSI patients with suspected or confirmed MRSA involvement is estimated to save US hospitals approximately 9.3-12.9% per year by reducing hospital admissions and lowering drug administration burden.

Fig. 1

Decision-analytic framework for acute bacterial skin and skin structure infection patient management. ABSSSI acute bacterial skin and skin structure infection, AE adverse event, G+ Gram-positive pathogens, IV intravenous, MRSA methicillin-resistant Staphylococcus aureus, PO oral

Fig. 2

Budget impact analysis for a US hospital with 1000 acute bacterial skin and skin structure infection patients eligible for intravenous methicillin-resistant Staphylococcus aureus-active antibacterials: a total annual costs and budget impact by setting and net savings for hospitals with ambulatory services; and b total annual costs and budget impact by setting and net savings for hospitals without ambulatory services. ED emergency department

Fig. 3

Total annual cost by cost category for a US hospital with 1000 acute bacterial skin and skin structure infection patients receiving intravenous MRSA-active antibacterials: a total annual cost by cost category for hospitals with ambulatory services; and b total annual cost by cost category for hospitals without ambulatory services. For the base case and scenario, pharmaceutical represents the drug acquisition costs only for all antibacterials included in the model; hospitalization is the cost of inpatient stay excluding costs associated with pharmaceuticals, drug administration, laboratory tests, and monitoring associated with MRSA-active antibacterials included in the model, adverse events, and readmissions; drug administration is the costs associated with drug administration, excluding pharmaceutical acquisition costs; lab is the costs of laboratory tests and monitoring associated with MRSA-active antibacterials included in the model; AE is the cost associated with the adverse events listed in Table 1; and readmission represents the costs associated with 30-day re-hospitalization. AE adverse event, MRSA methicillin-resistant Staphylococcus aureus

Fig. 4

Univariate analysis: impact of a ±20 % change on total estimated costs for hospitals with ambulatory services. Only the top 15 most impactful variables on the total costs are included in figure. ORI oritavancin, VAN vancomycin, INPAT inpatient, DAP daptomycin, MRSA methicillin-resistant Staphylococcus aureus, LIN linezolid, OBS observation