Use of Oritavancin to Expedite Discharge Proves Cost-Effective in ABSSSI Patients

Cristen Whittaker, PharmD, explains the findings of an analysis that compared length of stay, readmission, and costs in patients with ABSSSIs who received oritavancin or vancomycin.

Acute bacterial skin and skin structure infections (ABSSSIs) are often associated with imposing high economic burdens on institutions due to the nature of prolonged hospital stays and high rates of infection recurrence.

In a Poster Abstract Session at ID Week 2018 held this year in San Francisco, California, investigators from AtlantiCare Regional Medical Center in Pomona, NJ, presented the findings of their study which evaluated the economic comparison between the use of vacomycin and oritavancin for the treatment of hospitalized patients at their facility for ABSSSIs.

In an exclusive interview with Contagion®, Cristen Whittaker, PharmD, a clinical pharmacist at AtlantiCare Medical Center (ARMC), spoke about the study and the new protocol at the institution that is being used to help identify patients who are candidates for reducing length of stay by receiving treatment with oritavancin (see video).

“Oritavancin and vancomycin are similar in what they cover,” Dr. Whittaker explained, “They both cover gram-positive organisms including Staphylococcus and Streptococcus that live on your skin. In terms of administration, oritivancin is a single-dose whereas vancomycin has to be given once or multiple times a day, depending on the patient’s renal function.”

For the study, Dr. Whittaker and her team sought to primarily determine 30-day ABSSSI recurrence between 2 treatment arms—1 of patients treated with oritavancin and the other of patients treated with vancomycin. The secondary endpoints of the study were to evaluate the financial expenditures associated with each treatment arm as well as assess for potential risk factors associated with poor outcomes.

The retrospective analysis followed a total of 101 patients treated as inpatients for ABSSSI between May 2017 and January 2018 at ARMC. Patients who received oritavancin were only included if the treatment was administered with the purpose of expediting discharge.

The investigators reviewed demographics and past medical history, including previous skin infections and length of stay. Of 101 patients, 11 patients returned to ARMC within 30 days of discharge and were evaluated as part of the study.

Of the patients who required readmission, 9 were a part of the vancomycin treatment arm (18%) and 2 were a part of the oritavancin group (4%). From the total 11 patients who had recurrent infections, 6 were current injection drug users (55%), 3 left against medical advice at their initial visit (27%) and 7 had an emergency department visit in the prior 30 days for the same infection (64%),

A financial analysis was performed for all 101 patients in the study based on the DRG (diagnosis-related group) and hospital-specific expenditures were provided by the ARMC finance department.

On average, patients who received oritavancin had a length of stay of 3.3 days on average. The total cost of hospital admission was $462,825 in this patient population. With the cost of oritavacin being $2,700 per patient for administration with oritavancin, the total cost was $137,700. The total DRG reimbursement was $279,021 which incurred a total cost of $321,504 for ARMC.

In the vancomycin arm, the average length of stay was 5.6 days, thus creating a total of $770,000 in hospital admission costs. The total DRG reimbursement was totaled at $275,500, incurring a total cost of $494,500 for ARMC.

Dr. Whittaker summarized the study’s financial conclusions to Contagion® (see video).

“In terms of cost-avoidance, even though we spent a significant amount of money for the medication, about $2700, we saved money in the long run,” Dr. Whittaker explained.

Overall, use of vancomycin resulted in 111.7 hospitalization days, which was avoided in the 51 patients receiving oritavancin, resulting in an estimated cost avoidance of $217,206 compared to conventional treatment with vancomycin. Excluding readmission costs, the facility saved $172,996.

The authors conclude that using oritivancin appears to be an effective and financially beneficial treatment for ABSSSI.