Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
CJEM. 2022 Aug;24(5):520-528. doi: 10.1007/s43678-022-00320-1. Epub 2022 Jun 8.
Emergency department (ED) patients with cellulitis requiring intravenous antibiotics may be treated via outpatient parenteral antibiotic therapy (OPAT) as opposed to hospitalization. The primary objective was to compare healthcare costs for the following strategies: community intravenous antibiotics with referral to an OPAT clinic operated by infectious disease specialists ('OPAT clinic' strategy); community intravenous antibiotics with return to ED if necessary ('return to ED' strategy); and hospital admission.
Using a hospital administrative database, we conducted a cost analysis using patient-level data of adult cellulitis patients presenting to two tertiary care EDs and were treated with intravenous antibiotics in one of three ways: OPAT clinic strategy; return to ED strategy; and hospital admission. Costs were estimated from Canada's publicly funded health system perspective. The primary outcome was the mean total cost (2015 CAD) per patient for each treatment strategy. A generalized linear model was performed to adjust for baseline characteristics, including age, sex and comorbidities.
A total of 808 patients met inclusion criteria: OPAT clinic strategy (N = 341); return to ED strategy (N = 228) and hospital admission (N = 239). The mean total cost of care for the treatment strategies were: OPAT clinic: $2170 (95% CI $1905-$2436); return to ED: $1493 (95 %CI $1264-$1722); and hospital admission: $10,145 (95% CI $8668-$11,622). Results from the regression analysis suggested that the OPAT clinic strategy was associated with a cost-saving of $7394 (95% CI $6154-$8633, p < 0.001) compared to hospital admission and an increased cost of $651 (95% CI $367-$935, p < 0.001) when compared to the return to ED approach.
This is the first Canadian study that compares the cost of different OPAT strategies for cellulitis patients. While both OPAT strategies are safe and far less costly than hospital admission, our findings suggest that a dedicated OPAT clinic for patients with cellulitis is more expensive than the return to ED strategy.
需要静脉使用抗生素的蜂窝织炎急诊（ED）患者可以通过门诊静脉抗生素治疗（OPAT）进行治疗，而不是住院治疗。主要目的是比较以下策略的医疗保健成本：由传染病专家运营的 OPAT 诊所（“OPAT 诊所”策略）转介的社区静脉内抗生素；如果需要，返回 ED 的社区静脉内抗生素（“返回 ED”策略）；和住院。
使用医院行政数据库，我们对来自两家三级保健 ED 的成年蜂窝织炎患者的患者水平数据进行了成本分析，这些患者通过以下三种方式之一接受静脉内抗生素治疗：OPAT 诊所策略；返回 ED 策略；和住院。成本是从加拿大公共资助的卫生系统的角度估算的。主要结果是每位患者每种治疗策略的平均总成本（2015 加元）。进行了广义线性模型以调整基线特征，包括年龄，性别和合并症。
共有 808 名患者符合纳入标准：OPAT 诊所策略（N=341）；返回 ED 策略（N=228）和住院治疗（N=239）。治疗策略的总护理费用平均值为：OPAT 诊所：$2170（95%CI$1905-$2436）；返回 ED：$1493（95%CI$1264-$1722）；和住院治疗：$10145（95%CI$8668-$11,622）。回归分析的结果表明，与住院治疗相比，OPAT 诊所策略可节省$7394（95%CI$6154-$8633，p<0.001），与返回 ED 方法相比，增加了$651（95%CI$367-$935，p<0.001）的成本。
这是第一项比较加拿大蜂窝织炎患者不同 OPAT 策略成本的研究。尽管这两种 OPAT 策略都安全且远低于住院治疗的成本，但我们的研究结果表明，为蜂窝织炎患者设立专门的 OPAT 诊所比返回 ED 策略的成本更高。
