Valerio Maricela, Veintimilla Cristina, Rodríguez Carmen, de la Villa Sofía, Sánchez-Somolinos Mar, Cerezales Mónica, Crespo Carlos, Rodríguez Sara, Adán Iván, Chamorro Esther, Rosselló Irantzu, Muñoz Patricia
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
J Med Econ. 2023 Jan-Dec;26(1):463-472. doi: 10.1080/13696998.2023.2190704.
Dalbavancin is an antibiotic with activity against gram-positive bacteria that allows early discharge of patients requiring intravenous therapy. Outpatient treatment helps offset hospitalisation costs associated with standard intravenous treatment. Our objective was to assess the cost of disease management, including treatment with dalbavancin, in a Spanish hospital for 1 year, and the hypothetical costs associated with treatment with other therapeutic alternatives to dalbavancin.
A single-centre, observational, retrospective post-hoc analysis was conducted based on electronic medical records analysing all patients who received dalbavancin treatment throughout 1 year; cost analysis was performed for the whole process. In addition, three scenarios designed on the basis of real clinical practice by clinical experts were hypothesised: (i) individual therapeutic alternative to dalbavancin, (ii) all patients treated with daptomycin, and (iii) all days of dalbavancin as outpatient treatment transformed into hospital stay. Costs were obtained from the hospital.
Thirty-four patients were treated with dalbavancin; their mean age was 57.9 years, and 70.6% were men. The main reasons for dalbavancin use were outpatient management (61.7%, = 21) and ensuring treatment adherence (26.5%, = 9). The main indications were: osteoarticular infection (32.4%) and infective endocarditis (29.4%). One-half (50%) of the infections were due to (23.5% were methicillin resistant). All patients achieved clinical resolution, and no costs associated with dalbavancin-associated adverse events or re-admissions were reported. The mean total cost of treatment was 22,738€ per patient, with the greatest expenditures in interventions (8,413€) and hospital stay (6,885€). The mean cost of dalbavancin treatment was 3,936€; without dalbavancin, this cost could have been increased to 3,324-11,038€ depending on the scenario, mainly due to hospital stays.
Limited sample size obtained from a single centre.
The economic impact of the management of these infections is high. The cost of dalbavancin is offset by the decreased length of stay.
达巴万星是一种对革兰氏阳性菌有活性的抗生素，可使需要静脉治疗的患者提前出院。门诊治疗有助于抵消与标准静脉治疗相关的住院费用。我们的目的是评估西班牙一家医院为期1年的疾病管理成本，包括使用达巴万星治疗的成本，以及与使用达巴万星其他治疗替代方案相关的假设成本。
基于电子病历进行单中心、观察性、回顾性事后分析，分析了全年接受达巴万星治疗的所有患者；对整个过程进行成本分析。此外，假设了临床专家根据实际临床实践设计的三种情景：（i）达巴万星的个体治疗替代方案，（ii）所有患者接受达托霉素治疗，（iii）将达巴万星门诊治疗的所有天数转换为住院治疗。成本从医院获取。
34例患者接受了达巴万星治疗；他们的平均年龄为57.9岁，70.6%为男性。使用达巴万星的主要原因是门诊管理（61.7%，n = 21）和确保治疗依从性（26.5%，n = 9）。主要适应症为：骨关节炎感染（32.4%）和感染性心内膜炎（29.4%）。一半（50%）的感染由[具体细菌名称未给出]引起（23.5%为耐甲氧西林菌）。所有患者均实现临床缓解，未报告与达巴万星相关不良事件或再次入院相关的成本。每位患者的平均总治疗成本为22,738欧元，干预费用（8,413欧元）和住院费用（6,885欧元）支出最大。达巴万星治疗的平均成本为3,936欧元；若无达巴万星，根据情景不同，该成本可能增至3,324 - 11,038欧元，主要是由于住院时间。
从单一中心获得的样本量有限。
这些感染管理的经济影响较高。达巴万星的成本因住院时间缩短而得到抵消。
