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Observational Study
. 2023 Jun;36(3):291-301.
doi: 10.37201/req/134.2022. Epub 2023 Apr 5.

Economic burden of skin and skin structure infections due to Gram-positive bacteria in patients on hospital at home-based outpatient parenteral antibiotic therapy (OPAT)

M Mirón-Rubio  1 , J J Parra Jordán, V J González Ramallo, A Mujal Martínez, J Fernández Muixí, M Iglesias Gallego, M C Lucas Núñez, E Rodado Alabau, S Vidal Perez-Campoamor, E Uría
Affiliations
Observational Study

Economic burden of skin and skin structure infections due to Gram-positive bacteria in patients on hospital at home-based outpatient parenteral antibiotic therapy (OPAT)

M Mirón-Rubio et al. Rev Esp Quimioter. 2023 Jun.

Abstract
in English, Spanish

Objective: To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain.

Methods: Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros.

Results: We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was €7,326 (95% confidence interval: €6,316-€8,416).

Conclusions: Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission.

Objetivo: Describir y cuantificar el uso de recursos y costes directos sanitarios asociados con las infecciones de piel y tejidos blandos (IPPB) causadas por microorganismos gram-positivos en adultos que recibieron tratamiento antimicrobiano domiciliario endovenoso (TADE), administrado en unidades de hospitalización a domicilio (HaD) en España.

Material y métodos: Estudio observacional, multicéntrico, retrospectivo. Se incluyeron pacientes adultos de ambos sexos, incluidos en el Registro TADE en el periodo 2011 a 2017 y cuyo motivo de ingreso fue una IPPB causada por un micro-organismo Grampositivo. El uso de recursos incluyó las visitas a domicilio (enfermería y médico), visitas a urgencias, estancia en hospitalización convencional, estancia en HaD y tratamiento antibiótico. Los costes se cuantificaron multiplicando las unidades naturales de los recursos por el coste unitario correspondiente. Todos los costes fueron actualizados a euros de 2019.

Resultados: Se incluyeron 194 episodios (189 pacientes) procedentes de 24 centros españoles. Los diagnósticos principales más frecuentes fueron celulitis (26,8%) e infección por herida quirúrgica (24,2%). El 94% de los episodios resultaron en una mejoría o curación clínica al finalizar el tratamiento. La mediana de la estancia en HaD fue de 13 días (rango intercuar- tílico [RI]:8-22,7), con una estancia previa en hospitalización convencional de 5 días (RI: 1-10,7). El coste total promedio atribuible al proceso infecciosos completo fue de 7.326€ (in-tervalo de confianza del 95%: 6.316€-8.416 €).

Conclusiones: Este estudio sugiere que el TADE administrado en HaD es una alternativa segura y eficiente para el manejo de estas infecciones y podría conducir a menores costes en comparación con el ingreso hospitalario.

Keywords: Hospital at home; cost analysis; outpatient parenteral antimicrobial therapy; skin and skin structure infections.

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Conflict of interest statement

Manuel Mirón Rubio received fees as a speaker in conferences from Merck Sharp and Dohme, Aldo-Unión Lab, and has lectured at meetings organized by pharmaceutical companies (Merck Share and Dohme, Rovi, Angelini Pharma) or participated in some medical advice.

Juan José Parra Jordán reported no conflicts of interest

Víctor José González Ramallo received fees as a speaker in

conferences from Advanz Pharma, Angelini and MSD

Abel Mujal Martínez received fees as a speaker in conferences from MSD and Advanz Pharma.

Josefina Fernández-Muixí reported no conflicts of interest.

Marina Iglesias Gallego reported no conflicts of interest.

María Cruz Lucas Núñez reported no conflicts of interest

Elisa Rodado Alabau reported no conflicts of interest.

Sandra Vidal Perez-Campoamor is an employee of Merck Sharp& Dohme

Estefany Uría is an employee of Pharmalex Spain

Figures

Figure 1
Figure 1
Depiction of the complete infectious episodes, covering the time from inpatient hospitalisation, if any, until HaH discharge, including possible returns to the hospital related to the infectious process.
Figure 2
Figure 2
Flowchart of the episodes included in the analysis SSSIs, skin and skin structure infections.
Figure 3
Figure 3
Hospital stay and total cost associated with episodes of SSSIs due to Gram-positive bacteria according to main diagnosis SSSIs, skin and skin structure infections; IR, interquartile range; CI, confidence interval.
See this image and copyright information in PMC

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