Cost-Effectiveness of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Care Coordination Service

Background: Patients needing long-term parenteral antimicrobial therapy are often discharged from the hospital to complete this treatment at home. A 2013 paper showed the effect of a pharmacist-led care coordination service, the infectious diseases transitions service (IDTS) on improving processes of care and complications among patients on outpatient parenteral antimicrobial therapy (OPAT).¹ However, little is known about the cost-effectiveness of the resource-intensive IDTS compared to the standard of care (no care-coordination service). The objective of this study was to assess the cost-effectiveness of the infectious disease transition service compared to standard of care for patients discharged on OPAT.

Methods: Data regarding patient outcomes was abstracted from prior work.¹ The main cost of the intervention was the cost for an 0.8 full-time equivalent pharmacist. A Markov Model for cost-effectiveness analysis was carried out over a twelve-month time horizon from the societal perspective, which includes costs to the patient and to the healthcare system. We used 1,000 Monte-Carlo simulations to carry out probabilistic sensitivity analysis.

Results:

Compared to standard of care (average cost per OPAT patient, $56.257.65 and 5.716 life-years by the end of the year), the IDTS improved survival at a lower cost (average cost per OPAT patient, $47,191.96 and 5.734 life-years). This led to a deterministic incremental cost-effectiveness ratio (ICER) of -$498,410.75 per life-year gained suggesting that IDTS intervention dominates standard of care approach. This compares well with the widely-accepted willingness to pay threshold of $50,000 per life-year gained. Based on this, the probabilistic sensitivity analysis showed that IDTS compared to standard of care was cost-effective in 71% of Monte-Carlo simulations.

Conclusion: Our analyses showed that IDTS intervention is cost-effective compared to the standard of care based a willingness to pay threshold of $50,000. It improved survival at a lower cost. Healthcare systems and payers should consider these results when deciding whether to fund OPAT care coordination services.

¹Keller SC, Ciuffetelli D, Bilker W, et al. The Impact of an Infectious Diseases Transition Service on the Care of Outpatients on Parenteral Antimicrobial Therapy. J Pharm Technol 2013;29:205-14.