High Adherence and Cost Savings with Home OPAT Provided Through Infectious Disease Physician Office Infusion Centers
SUGAR LAND, TX – (January 25, 2023) Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be safe and effective for self-administration but can lead to non-adherence. OPAT provided through a physician office infusion center (POIC) with pharmacy services allows patients to receive intravenous antibiotics (IVAB) outside of a hospital, but still under close supervision of the treating infectious disease physician and care of skilled infusion nurses and pharmacists. Patients typically come to the POIC weekly for catheter care, laboratory collection, medication pick-up and as needed provider visits. Often, close provider oversight allows for de-escalation of OPAT. A multicenter, retrospective study evaluated adherence to therapy and POIC visits along with cost savings associated with therapy de-escalation in patients receiving self-administered OPAT through POICs.
In this study, 125 of 2180 patients receiving home OPAT in 2021 were randomly selected from 13 POICs nationally. Predominant infections were bone and joint (38%), complicated skin (18%), intra-abdominal (15%) and bacteremia (14%). Cephalosporins were most frequently used (51%) followed by carbapenems (21%) and daptomycin (19%). Mean age was 50±18 years with 52% males. Mean OPAT duration was 38±9 days, driven primarily by a longer length of therapy for bone and joint patients.
Adherence to home OPAT was assessed for scheduled POIC visits and prescribed IVAB doses. Patients completed 703/706 scheduled visits (99.6%) with a mean of 6±3 POIC visits during the therapy course. Of the 3 non-adherent visits, 2 were delayed by 2 days and 1 was missed due to hospitalization. OPAT was completed in 118 patients (94.4%) Five patients discontinued prematurely due to adverse events or unplanned hospitalization. Overall IVAB dose adherence rate was 99.3% with 51 doses missed of 7315 dispensed. De-escalation during OPAT, including switch to oral or discontinuation of IVAB, was achieved in 52 patients, saving 533 doses equating to 307 days of OPAT (2.4 days/patient). Based on an average daily OPAT cost of $140, this saved $42,980 in the randomized cohort and an estimated $749,571 annually in the entire population of 2180 patients.
The study concluded that home OPAT through an infectious disease POIC was associated with a very high rate of adherence for scheduled POIC visits and IVAB dose adherence across multiple types of infections with long lengths of therapy. Weekly visits to the POIC contributed to high adherence to planned therapy. Additionally, close physician therapy oversight resulted in estimated healthcare cost savings of almost $750,000 annually through onsite antimicrobial stewardship and therapy management.
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IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medical Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP). IDWeek 2022 was a hybrid conference that took place from October 19-23, 2022, in Washington, DC.
Clifford P Martin, MD, Thomas K Sleweon, MD, Quyen Luu, MD, Richard C Prokesch, MD, FACP, FIDSA, Robin H Dretler, MD, Barry Statner, MD, FRCPC, FIDSA, Kent J Stock, DO, Claudia P Schroeder, PharmD, PhD, Lucinda J Van Anglen, PharmD, 1006. High Adherence and Cost Savings with Home OPAT Provided through Infectious Disease Physician Office Infusion Centers, Open Forum Infectious Diseases, Volume 9, Issue Supplement_2, December 2022, ofac492.847, https://doi.org/10.1093/ofid/ofac492.847