Medicare coverage of outpatient ambulatory intravenous antibiotic therapy: a program that pays for itself

Abstract

A number of studies have documented the safety, efficacy, and cost-effectiveness of outpatient intravenous (i.v.) antibiotic therapy for patients with infectious diseases. Nevertheless, Medicare policy prohibiting coverage of outpatient, self-administered drugs has severely limited access of Medicare patients to ambulatory i.v. therapy, thus forcing them to rely on more costly, impatient hospital care. To test the hypothesis that a new Medicare benefit providing coverage for ambulatory i.v. antibiotic therapy could significantly reduce the program's expenditures for the treatment of infectious diseases (including pneumonia, osteomyelitis, cellulitis, and endocarditis), a cost model was constructed with use of patient care information from the clinical literature as well as clinical experts, Medicare data, and other medical claims databases. The model shows cumulative 5-year savings of nearly $1.5 billion associated with the new Medicare benefit. Policy makers should consider implementing such a benefit.