686. Re-hospitalization and Direct Medical Costs Among Patients Treated with Linezolid (LZD) versus Vancomycin (VAN) Following Hospitalization for Complicated Skin and Skin Structure Infections (cSSSI)
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • ZY11-096 Re-hospitilization-IDSA11.pdf (149.5 kB)
  • Background: Patients hospitalized for cSSSI are at risk for re-hospitalization and high costs after discharge. This study compared re-hospitalization rates and total direct medical costs among cSSSI patients treated with either LZD or VAN post-discharge.

    Methods: Two administrative claims databases were pooled and adult patients (18-64 years) who were hospitalized for cSSSI and treated post-discharge with either LZD or VAN from 1/1/2007 through 9/30/2009 were identified.  Patients who received LZD or VAN for bone/joint/device infections, infective endocarditis, meningitis, necrotizing fasciitis, and gangrene were excluded.  Multivariable regression analyses examined (1) re-hospitalizations and (2) total direct medical costs within 6 weeks following discharge, controlling for key demographic and clinical variables. Costs were categorized as inpatient, outpatient, and pharmacy costs.

    Results: Among 7,260 patients hospitalized with a cSSSI, 42.6% (n=3,093) received LZD and 57.4% (n=4,167) received VAN following discharge. LZD and VAN users’ demographic and clinical characteristics were similar, but VAN users had higher baseline comorbidities, longer length of stay and higher rates of bacteremia during index hospitalizations (controlled for in the regression).  Following discharge, patients treated with LZD had lower re-hospitalization rates compared to VAN (Table 1). Post-discharge pharmacy costs were higher for LZD users, while outpatient, inpatient, and total costs were higher for VAN users (Table 1). Controlling for covariates, LZD users were less likely to be re-hospitalized (OR= 0.63; 95%CI=0.57, 0.71) and had 31.4% lower medical costs (P<0.0001).

    Conclusion: Among commercially-insured patients with cSSSI hospitalizations, LZD was associated with lower post-discharge re-hospitalization rates and direct medical costs compared to VAN.

    Table 1.

     

    LZD

    VAN

    P-value

    Rehospitalization Rates (%)

    24.4%

    36.0%

    All P<0.0001

    Post-discharge Costs: (mean ± SD; median)

    Total Direct Medical Costs

    $7,378 ± $22,486; $2,703

    $10,065 ± $25,072; $4,407

    Pharmacy Costs

    $2,356 ± $2,490;

    $1,657

    $1,891 ± $5,167;

    $798

    Outpatient Costs

    $1,546 ± $3,544;

    $362

    $4,052 ± $5,137;

    $2,505

    Inpatient Costs

    $2,355 ± $20,638;

    $0

    $4,122 ± $23,332;

    $0


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    C. Daniel Mullins, PhD1, H. Keri Yang, PhD, MPH1, Eberechukwu Onukwugha, PhD1, Debra Eisenberg, MS, PhD2, Daniela E. Myers, MPH3, David Huang, MD, PhD, MPH3 and Thomas Lodise, PharmD4, (1)Pharmaceutical Health Services Research, University of Maryland, School of Pharmacy, Baltimore, MD, (2)Outcomes Research, HealthCore Inc, Wilmington, DE, (3)Pfizer Inc., Collegeville, PA, (4)Albany College of Pharmacy, Albany, NY

    Disclosures:

    C. D. Mullins, Pfizer Inc.: Consultant, Grant Investigator and Scientific Advisor, Consulting fee and Research grant

    H. K. Yang, Pfizer Inc.: Grant Investigator, Research grant

    E. Onukwugha, Pfizer Inc.: Consultant and Grant Investigator, Consulting fee and Research grant

    D. Eisenberg, HealthCore Inc.: Employee, Salary

    D. E. Myers, Pfizer Inc.: Employee and Shareholder, Salary

    D. Huang, Pfizer Inc.: Employee and Shareholder, Salary

    T. Lodise, Pfizer Inc.: Collaborator, Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.