Outpatient Treatment of Infective Endocarditis (IE) at Physician Office Infusion Centers (POICs): A 2-Year Analysis of Clinical and Economic Outcomes

Background: IE is life-threatening and requires prolonged intravenous (IV) antibiotics. Infectious Disease (ID) physician management of IE from the inpatient (IP) setting into ID-based POIC can provide closer monitoring and supervision compared to traditional outpatient (OP) settings with demonstrated improved outcomes, reduced/avoided IP stay, and associated cost savings. POICs provide a desirable alternative to home care, extended care facilities or other OP settings for treatment of IE. This study assesses clinical and economic outcomes of ID POIC-managed IE.

Methods: A multicenter, retrospective review was conducted of IE patients (pts) treated at 10 POICs in 2014-2015. Data collected were demographics, comorbidities, Charlson index (CI), IP stay, disease and therapy (tx) characteristics, clinical outcomes, readmissions and adverse events (AEs). Economic outcomes were measured from costs of total IP days saved by tx in the POIC and assessment of costs of other care settings. Costs were derived from a national database and published data. Student’s t-test was used for analysis.

Results: 152 IE pts were included (97 native valve, 24 mechanical valve, 20 bioprosthetic valve, and 11 lead). Mean age was 58 years (38% ≥ 65 years), 72% male and 11% IV drug users. 95% had ≥ 1 predisposing factor for IE. Mean CI was 5. Average length of tx was 40.7 days, including 8.9 IP days. This compared with 12.5 mean IP days nationally, saving 3.6 IP days. Five pts received all tx in the POIC. Etiology included viridans streptococci (34%), Staphylococcus aureus (28%) and enterococci (14%). 86% of pts successfully completed IE tx with 5% hospitalized for valve replacement, all returning to the POIC for tx completion. Unplanned hospitalization occurred in 13% due to disease exacerbation or complications. Drug-related AEs occurred in 34 pts with 88% mild to moderate. Estimated costs for traditional care with 12.5 IP days were $5.2 million compared to $3.7 million for actual IP days of POIC pts, generating cost savings of $1.5 million (p<0.0001). Additionally, POIC care can result in cost savings of more than $1000 per day compared to other OP settings.

Conclusion: IE pts with considerable comorbidities were successfully managed by ID physicians through a POIC. IP stay was reduced or avoided; readmissions were low with significant cost savings compared to other settings of care.