Outpatient parenteral antibiotic therapy (OPAT) is an accepted model of care for children, as it reduces the negative psychosocial impact of hospital admission and the risk of hospital-acquired infection. However evidence for the overall cost-effectiveness of this strategy is lacking, with the concern that OPAT may benefit healthcare providers/institutions but not patients/families. This health economic analysis aimed to address both healthcare and societal perspectives, by compare the cost-effectiveness of OPAT at home for moderate/severe cellulitis to standard hospital care.
An economic evaluation was conducted of patients recruited to a randomized control trial from Jan 2015-Jun 2017. Children aged 6 m-18 y presenting to the emergency room (ER) with moderate/severe cellulitis were randomized to receive either intravenous antibiotics at home via OPAT or standard care in hospital. The costs considered were the OPAT service cost for the home treatment group, the inpatient admission cost for the hospital group, and costs to families. Costs were collected using hospital administrative cost data for each patient and cost questionnaires completed by parents, which included parental leave taken from work, medication and transport costs incurred. The effectiveness was measured in quality-adjusted life years (QALY) using the Child Health Utility 9D, a well validated health-related quality of life assessment tool.
188 children were included in the study. The total cost per patient for the healthcare institution was significantly lower for the OPAT group compared to the hospital group (US$1136 vs US$2124, p<0.001). The mean cost to a family was US$160 for the home group compared to USD$552 for the hospital group (p<0.001), which was primarily accounted for by parentsÕ days taken off paid work. ChildrenÕs health utility was significantly higher in the OPAT group compared to the hospital group (0.86 versus 0.75, p<0.001). OPAT was less costly and more effective thus dominant (figure), and estimating the incremental cost-effectiveness ratio is redundant.
OPAT for children with moderate/severe cellulitis is less costly for both healthcare providers and families, in addition to being more effective compared to standard care to a hospital ward.
S. Hopper, None
K. Dalziel, None
F. Babl, None
P. Bryant, None
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