637. Clinical and Economic Outcomes of Outpatient Parenteral Antimicrobial Therapy (OPAT) among Indigent Patients: A Retrospective Multicenter Analysis
Session: Oral Abstract Session: Outpatient Antimicrobial Therapy
Friday, October 4, 2013: 9:45 AM
Room: The Moscone Center: 300
Background:   OPAT is known to be beneficial to patient safety, clinical outcome and cost savings.  Earlier hospital discharge of patients requiring intravenous antibiotics (IVAB) allows for increased mobility, better quality of life and cost savings.  Establishment of a hospital-funded indigent healthcare program (IHP) allows qualified patients to receive IVAB at a physician office infusion center (POIC). The database presented is an extension of a pilot study of an IHP.  

Methods:   A retrospective multicenter analysis was conducted among 11 POICs for patients receiving OPAT under the IHP program during 2012.  Data extracted include patient demographics, diagnosis, drug treatment, clinical and economic outcomes.  Costs were calculated by comparing daily OPAT charges to avoided hospital costs as derived from Healthcare Cost and Utilization Project (HCUP) database 2010.  The t-test was used to determine statistical significance.

 Results: A total of 90 patients (9 to 77 yrs of age) received IVAB following hospital discharge across 11 POIC sites.  The most frequent diagnoses were osteomyelitis (n=25), cellulitis (n=16), endocarditis (n=11), septic arthritis (n=8), genitourinary infections (n=6), and septicemia (n=4). The most commonly prescribed IVABs were vancomycin (36%), cefazolin (17%), and ceftriaxone (15%).  The majority of patients (81%) self-administered IVAB at home using elastomeric devices.  Eighty patients completed therapy of which 73% were clinically cured and 16% were improved with partial resolution of signs and symptoms. Treatment failure rate as defined by worsening of infection or failure to comply with therapy was reported in 11% and 4 of 10 failed due to non-compliance. The estimated daily cost per POIC patient was $173.6 ± 12.6 with a mean length of stay (LOS) of 22 ± 13 days.  In comparison, the national estimate for hospital use of uninsured patients is $2188.7 ± 437 a day with a mean LOS of 7.3 ± 0.9 days.  As a result, the average cost per patient using OPAT via POIC were reduced by $2015 per day (p<0.0001) or 76% of inpatient hospital costs.

Conclusion: This study indicates that OPAT via POIC offers a safe and effective option for treating a wide variety of infections in non-resource patients.  It provides high-quality, patient-centered care with a significant reduction of healthcare costs.

Richard M. Mandel, MD, FIDSA1,2, Brian Metzger, MD, MPH3, Claudia P. Schroeder, PharmD, Ph.D4 and Lucinda J. Van Anglen, PharmD4, (1)Southern Arizona Infectious Disease Specialists, PLC, Tucson, AZ, (2)Medicine, University of Arizona College of Medicine, Tucson, AZ, (3)Austin Infectious Disease Consultants, Austin, TX, (4)Healix Infusion Therapy, Inc., Sugar Land, TX

Disclosures:

R. M. Mandel, None

B. Metzger, None

C. P. Schroeder, None

L. J. Van Anglen, Merck: Investigator, Research support

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