Healthcare Resource Utilization for High-Risk Patients Treated with Dalbavancin in Physician Office Infusion Centers (POICs)

Background: Medicare beneficiaries and patients (pts) ≥65 years comprise the highest risk for utilization of healthcare resources including emergency department (ED) visits and hospitalizations (hosp). Dalbavancin (DAL) is a long-acting lipoglycopeptide approved for treatment of bacterial skin and skin structure infections, well suited for outpatient therapy due to a 1-2 dose regimen. We investigated the use of healthcare resources following DAL with associated costs compared to national data.

Methods: A multi-center, retrospective chart review was conducted of all high-risk pts receiving DAL during 2017 at participating sites. Data included demographics, diagnosis, Charlson index, prior/post IV therapies, DAL regimen, and adverse drug reactions (ADRs). ED visits and hosp within 30 days post DAL were assessed and compared to Healthcare Cost and Utilization Project Nationwide Inpatient Sample and Nationwide Emergency Department Sample stratified by diagnosis. The inpatient length of stay (LOS) was used to calculate hospital charges.

Results: DAL was administered to 124 pts (mean age: 71±10 years, mean Charlson index of 4.6, 55% male) in 10 POICs. Most pts (92%) received a 1-dose regimen. Diagnoses included cellulitis (32%), abscess (22%), diabetic foot infection (15%), osteomyelitis (10%), surgical site infections (9%), prosthetic device infection (9%) and musculoskeletal infections (3%). 55% were treated from the community. IV therapy with other agents was provided prior to DAL in 58% and following DAL in 6%. Moderate to severe ADRs were seen in 12 pts (10%) with 4 admitted to the ED and 3 hosp. Median onset of ADRs was 5 days post DAL. All cause ED visits were 10 (8%), compared to a national rate of 10.6% based on diagnosis and age ≥65. All cause 30-day hosp admissions were 11.3% (14/124) compared to a national rate of 16.1% based on diagnosis. Mean inpatient LOS was 4.9 days compared to 5.3 days, resulting in healthcare resource cost savings of $97,014.

Conclusion: Use of DAL in high-risk, comorbid pts treated in POICs was associated with lower usage of both healthcare resources and corresponding costs than national estimates for respective diagnoses. AEs contributed to healthcare resource use. DAL provides a convenient outpatient treatment option for high-risk pts that may save use of healthcare resources.