Outpatient parenteral antibiotic therapy (OPAT) and inpatient treatment strategies for emergency department patients with cellulitis: a cost analysis

Inpatient Cost Avoidance and Uncompensated Labor Associated With Different Outpatient Parenteral Antimicrobial Therapy Care Models

Background

Outpatient parenteral antimicrobial therapy (OPAT) decreases length of stay and inpatient costs while benefiting patients. However, costs in the ambulatory setting are poorly quantified. To address this gap, we examined both inpatient costs avoided and uncompensated labor associated with OPAT delivered via 3 administration models: self-administration (S-OPAT), home care agencies/hemodialysis centers (HH-OPAT), and skilled nursing facilities (SNF-OPAT).

Methods

The length and type of treatment and postdischarge nonbillable encounters were reviewed via the electronic health record for all adult patients admitted to a large urban hospital and discharged on OPAT during two 3-month periods. Average daily inpatient care costs for Texas state hospitals and antibiotic wholesale acquisition costs were used to estimate OPAT costs and savings. Antibiotics with different formulations were converted to equivalent daily doses and their corresponding costs were averaged to estimate a daily cost.

Results

Among 342 patient records examined during the study periods, which accounted for 8656 inpatient days avoided, there were 211.1 nonbillable encounters per 100 patient-days of OPAT for patients discharged in SNF-OPAT, 9.1 in HH-OPAT, and 6.4 in S-OPAT (P = .028). The estimated cost avoided per 100 patient-days was $376 400 or approximately $5 430 197 per month.

Conclusions

A substantial burden of uncompensated labor was associated with all OPAT modalities; however, coordinating care with skilled nursing facilities was significantly more demanding when adjusted for days of OPAT. All OPAT models generated significant institutional savings, which are typically overestimated as they fail to account for the uncompensated support provided by the ambulatory care staff.

Quantifying cost savings from outpatient parenteral antimicrobial therapy programme: a systematic review and meta-analysis

Background

The outpatient parenteral antimicrobial therapy (OPAT) programme was introduced to reduce costs and enhance the quality of life for patients requiring prolonged treatment with parenteral antimicrobials. However, given the escalating inflation, the extent of current cost savings achieved through OPAT programmes remains unclear. This systematic review and meta-analysis employ a cost-minimization analysis to quantify the cost savings from OPAT compared to inpatient treatment.

Methods

The Cochrane Library, MEDLINE, Embase, PubMed and Web of Science databases were searched for studies comparing the costs of parenteral antimicrobial treatment without restriction on study design and year. Two reviewers conducted eligibility screening and cross-validated the extracted data. The cost data were adjusted and inflated to 2023 US dollars. A random effect model calculated mean differences (MD) with 95% confidence intervals (CI). The review protocol was registered on PROSPERO (CRD42024584201).

Results

Twenty studies involving 2790 patients were included in the systematic review, and six studies (three randomized controlled trials and three cohorts) were subject to metanalysis. Collectively, these included 560 patients who received treatment in outpatient settings, and 491 treated as inpatients. The cost of parenteral antimicrobial per episode of care was lower in the outpatient settings MD -$5436.73 (95% CI: -$9589.24 to -$1284.22, I² = 96%; P = 0.01) than in inpatient settings.

Conclusions

OPAT significantly saves costs compared to inpatient treatment. We recommend comprehensive analysis of treatment costs from all perspectives, including various cost types.

Current practices and challenges of outpatient parenteral antimicrobial therapy: a narrative review

Extended hospitalization for infection management increases inpatient care costs and the risk of healthcare-associated adverse events, including infections. The growing global demand for healthcare, the diminishing availability of hospital beds and an increasing patient preference for care within their own home have been the primary drivers of the expansion of hospital-in-the-home programmes. Such programmes include the use of IV antimicrobials in outpatient settings, known as outpatient parenteral antimicrobial therapy (OPAT). However, OPAT practices vary globally. This review article aims to describe the current OPAT practices and challenges worldwide. OPAT practice begins with patient evaluation and selection using eligibility criteria, which requires collaboration between the interdisciplinary OPAT team, patients and caregivers. Depending on care requirements, eligible patients may be enrolled to various models of care, receiving medication by healthcare professionals at outpatient infusion centres, hospital clinics, home visits or through self-administration. OPAT can be used for the management of many infections where an effective oral treatment option is lacking. Various classes of parenteral antimicrobials, including β-lactams, aminoglycosides, glycopeptides, fluoroquinolones and antifungals such as echinocandins, are used globally in OPAT practice. Despite its benefits, OPAT has numerous challenges, including complications from medication administration devices, antimicrobial side effects, monitoring requirements, antimicrobial instability, patient non-adherence, patient OPAT rejection, and challenges related to OPAT team structure and administration, all of which impact its outcome. A negative outcome could include unplanned hospital readmission. Future research should focus on mitigating these challenges to enable optimization of the OPAT service and thereby maximize the documented benefits for the healthcare system, patients and healthcare providers.

Outpatient parenteral antimicrobial therapy (OPAT) across the world: a comparative analysis-what lessons can we learn?

This paper presents a comparative analysis of Outpatient Parenteral Antimicrobial Therapy (OPAT) structures and delivery options across different countries. OPAT, a cost-effective alternative to inpatient care for patients requiring IV antimicrobial therapy, has demonstrated multiple benefits such as patient satisfaction, economic cost savings, and reduced hospital-acquired infections. Despite these advantages, there is considerable international variation in OPAT use and implementation. By examining the OPAT structures of multiple countries, we aim to identify areas of variation and explore opportunities for expansion and improvement of OPAT services.

A Bundle of the Top 10 OPAT Publications in 2022

Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications in 2022. Seventy-five articles were initially identified, with 54 being scored. The top 20 OPAT articles published in 2022 were reviewed by a group of multidisciplinary OPAT clinicians. This article provides a summary of the "top 10" OPAT publications of 2022.