Costs of outpatient parenteral antimicrobial therapy (OPAT) administered by Hospital at Home units in Spain (original) (raw)
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Cost-effectiveness of outpatient parenteral antibiotic therapy: a simulation modelling approach
Journal of Antimicrobial Chemotherapy, 2017
In the UK, patients who require intravenous antimicrobial (IVA) treatment may receive this in the community through outpatient parenteral antimicrobial therapy (OPAT) services. Services include: IVA administration at a hospital outpatient clinic (HO); IVA administration at home by a general nurse (GN) or a specialist nurse (SN); or patient self-administered (SA) IVA administration following training. There is uncertainty regarding which OPAT services represent value for money; this study aimed to estimate their cost-effectiveness. Methods: A cost-effectiveness decision-analytic model was developed using a simulation technique utilizing data from hospital records and a systematic review of the literature. The model estimates cost per QALY gained from the National Health Service (NHS) perspective for short-and long-term treatment of infections and service combinations across these. Results: In short-term treatments, HO was estimated as the most effective (0.7239 QALYs), but at the highest cost (£973). SN was the least costly (£710), producing 0.7228 QALYs. The combination between SN and HO was estimated to produce 0.7235 QALYs at a cost of £841. For long-term treatments, SN was the most effective (0.677 QALYs), costing £2379, while SA was the least costly at £1883, producing 0.666 QALYs. A combination of SA and SN was estimated to produce 0.672 QALYs at a cost of £2128. Conclusions: SN and SA are cost-effective for short-and long-term treatment of infections, while combining services may represent the second-best alternative for OPAT in the UK.
European Journal of Hospital Pharmacy, 2019
Objective To perform a cost-effectiveness and budget impact analysis from the perspective of the Spanish public healthcare system (SHS) to compare the number of overnight hospital stays avoided under a community and a hospital pharmacy model due to the administration of intravenous anti-infective therapy (IVAT) at a nursing home with 145 beds. Methods Analytical, observational, retrospective cohort study of a nursing home in Galicia (north-west Spain) that switched from a community to a hospital pharmaceutical management model. We compared the number of IVAT administrations, the number of hospital transfers and stays avoided, and mean annual costs avoided by the SHS before and after the switch. Costs were calculated using official SHS rates. results The switch from the community to the hospital pharmacy model resulted in 2.8 more IVAT administrations (95% CI, 2.71 to 2.88) and 20.79 fewer overnight hospital stays (95% CI, 20.07 to 21.51) per 100 nursing home beds a month (p<0.001). The net monthly avoided cost for the SHS was 9971.52 €2019. The budget impact analysis showed that implementation of this model throughout Galicia and Spain would respectively avoid costs of 13.78 and 221.21 million €2019 a year. Conclusions Hospital pharmacy models can contribute to a better optimisation of public healthcare resources and help improve the sustainability of the SHS.
Mediterranean journal of infection, microbes & antimicrobials, 2023
Introduction: Outpatient parenteral antimicrobial therapy (OPAT) is uncommon in Turkey and other developing countries, and its popularity has not increased at a satisfactory rate. We aimed to evaluate the direct and indirect cost analysis of an OPAT unit from the perspective of the Turkish health system using real-life data. Additionally, we aimed to investigate the clinical efficacy and safety of the OPAT unit and compare these parameters before and during the pandemic. Materials and Methods: Patients admitted to the OPAT unit between January 2019 and February 2021 were included in the study. The patients' medical records were obtained from the hospital's electronic database. Real-life data were used for the direct and indirect cost analyses of the OPAT unit. This data were obtained via in-person interviews. Results: In total, 307 patients were included in the study. The use of the OPAT unit saved 3040 bed days over 25 months. The end-of-treatment success rate was 92.2%. The presence of a urinary system infection, at least one comorbidity, and immunosuppressant administration were significantly higher in patients who were readmitted within 28 days for the same reason for which they were first admitted. The cost of OPAT was approximately 50% less than that incurred during hospitalization. Conclusion: Outpatient parenteral antimicrobial therapy units are effective, safe, and cost-effective in the context of the Turkish national health system.
Journal of Antimicrobial Chemotherapy, 2009
Objectives: Outpatient parenteral antibiotic therapy (OPAT) is an effective treatment strategy for a wide variety of infections as long as clinical risk is minimized by conforming to practice guidelines. However, its cost-effectiveness has not been established in the setting of the UK National Health Service. We examined the clinical efficacy and cost-effectiveness of an OPAT service based in a large UK teaching hospital, predominantly using the outpatient 'infusion centre' and patient/carer administration models of service delivery.
Hospital Practice
This study aimed to evaluate the efficiency of treatment of infectious endocarditis (IE) via Selfadministered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) supported by a shortening hospital admission program in a hospitalization-at-home unit (HAH), including a short review of the literature. Methods: Ambispective cohort study of 57 episodes of IE in 54 patients treated in an HAH unit between 1988 and 2014 who receive S-OPAT after prior intra-hospital clinical stabilization. Characteristics of each episode of IE, safety and efficiency of the care model, were analyzed. Results: Forty-three (76%) patients were males with a median age of 61 years (SD=16.5). A total of 37 (65%) episodes affected the native valve (42% the aortic valve). In 75%, a microorganism was isolated, of which 88% were Gram-positive bacteria. No deaths occurred during HAH program, clinical complications appeared in 30% of episodes, only 6 patients were re-admitted to hospital although no patient died. In the 12 months' follow-up 3 cases had a recurrence. The average cost of a day stay in HAH was €174 while in traditional cardiology hospitalization was €1100. The total average cost of treatment of each episode of IE managed entirely in hospital was calculated as €54,723. Application of the S-OPAT model based on HAH meant a cost reduction of 32.72%. Conclusions: In suitably selected patients, treatment of IE based on S-OPAT supported by a shortening hospital admission care program by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system.
A cost analysis of Outpatient Parenteral Antibiotic Therapy (OPAT): an Asian perspective
International Journal of Antimicrobial Agents, 2009
The concept of Outpatient Parenteral Antibiotic Therapy (OPAT) is relatively new in Asia. This study compared the actual costs and outcomes of care involving OPAT with conventional inpatient-only care at a university hospital in Singapore. Actual costs were obtained for selected patients enrolled in OPAT after 1 January 2005 and these costs were directly compared with those of age-, gender-and diagnosis-matched patients managed as inpatients only prior to the availability of OPAT in the preceding 12 months. Outcomes of patients were also considered. The OPAT and inpatient-only groups comprised 72 and 93 enrolments, respectively. Mean treatment duration for OPAT patients was 42.5 days versus 19 days for those receiving inpatient-only care (P < 0.001). The mean total treatment cost for OPAT and inpatient-only care was US$12 736 and 12403,respectively(P=0.706).MeancostperdayforcareincludinganOPATepisodewasUS12 403, respectively (P = 0.706). Mean cost per day for care including an OPAT episode was US12403,respectively(P=0.706).MeancostperdayforcareincludinganOPATepisodewasUS278 versus $457 per day for inpatient-only care (P < 0.001). There was no difference in outcomes between the two groups. OPAT is a viable alternative to inpatient care as it is safe, effective and results in lower daily costs. The trend to longer treatment courses is worthy of further review.
OPAT: proof of concept in a peripheral Belgian hospital after review of the literature
Acta clinica Belgica, 2018
Since its introduction in the 1970s in the United States, outpatient parenteral antibiotic/antimicrobial therapy (OPAT) has been adopted internationally for long-term intravenous (IV) treatment of stable infectious diseases. The aim is to provide a safe and successful completion of IV antimicrobial treatment at the ambulatory care center or at home without complications and costs associated with hospitalization. OPAT implementation has been accelerated by progress in vascular access devices, newly available antibiotics, the emphasis on cost-savings, as well as an improved patient comfort and a reduced incidence of health care associated infections with a similar outcome. OPAT utilization is supported by an extensive published experience and guidelines of the British Society of Antimicrobial Chemotherapy and the Infectious Diseases Society of America for adults as well as for children. Despite these recommendations and its widespread adoption, in Belgium OPAT is only fully reimbursed...
International Journal for Quality in Health Care, 2002
Background. As the cost of acute care in hospitals increases, there is an increasing need to find alternative means of providing acute care. Hospital in the home (HITH) has developed in response to this challenge. Current evidence is conflicting as to whether HITH provides cost savings compared with in-hospital care (IHC). The heterogeneous nature of HITH and the clinical complexity of patients is the greatest obstacle to making valid comparisons between the two modes of care. Objective. To compare costs and outcomes of HITH to IHC in hospitals in Victoria, Australia. Data sources/study setting. Hospital morbidity data and medical records from Victoria, Australia. Study design. A costing study of 924 randomly selected episodes of HITH care, individually matched to 924 comparable IHC episodes. Methods. Unadjusted total episode costs (TEC) and averaged daily costs for HITH and IHC were calculated. Mortality and length of stay (LOS) were compared for HITH and IHC episodes. Simple linear and multiple regression were used to analyse costing data, while logistic regression was used to compare in-hospital mortality and LOS in HITH versus IHC episodes. Principal findings. The 1848 episodes of care in the sample represented a heterogeneous range of acute conditions in 31 Victorian hospitals. HITH consisted of two distinct subgroups: pure-HITH (total episode substitution) and mixed-HITH (partial episode substitution). The cost of episodes of acute care containing a HITH component were overall 9% less expensive than IHC (P=0.04), while pure-HITH was 38% cheaper than matched IHC (P<0.001). The variable HITH, along with LOS and chemotherapy, explained the 60% variation in TEC. The mean cost of pure-HITH episodes was 22% lower compared to mixed-HITH (P=0.004). The in-hospital mortality rate in HITH (3.8%) and IHC (5.2%) was not significantly different. Pure-HITH was associated with shorter LOS, while mixed HITH was strongly associated with longer LOS. Conclusion. In our study the adjusted cost of HITH was significantly cheaper than IHC, particularly as total episode substitution. The cost needs to be adjusted because many factors other than HITH or IHC can influence crude costs. There may be potential for wider use of HITH for appropriately selected patients.
Outpatient Intravenous Antibiotic Therapy: Reduces economic burden of patients
OPAT it is a frequent source of questions and formal infectious diseases consultations. OPAT is always less expensive than inpatient therapy. Financial savings have been found with OPAT when compared with in hospital stays. The use of intravenous (IV) antibiotics for the treatment of serious infections has become common around the world. It is accepted as the standard treatment for many infectious diseases including other chronic infection like sepsis, meningitis, endocarditis etc. The goals of OPAT program are to provide expert care to patients on IV antibiotics, manage side effects and infections, reduces the need for hospital readmissions. The OPAT having a series of program patient care team includes doctors, nurses, and clinical and hospital pharmacists who are skilled in management of infectious diseases. Intravenous therapy outside the hospital, has only recently become possible, with the introduction of new Antibiotics, better catheters for vascular access, and improved infusion devices. Health care professionals have pioneered the development of OPAT and worked together to develop safe and effective programs. The antibiotics used for OPAT care are chosen for safety, effectiveness and ease of administration and money saving. The IV delivery system needed in the home is much simpler than the large, complicated IV pumps you see in the hospital. OPAT allows suitable patients on intravenous (IV) antibiotics to be discharged early from hospital and treated in their home or community setting by a team of specialist nurses.