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Clinical Outcomes and Economic Impact of Oritavancin for Gram-Positive Infections: A Single Academic Medical Center
Lauren E Brownell1, Meagan L Adamsick2, Erin K McCreary3
1Department of Pharmacy, University of Wisconsin Health, 600 Highland Avenue, MC 1530, Madison, WI, 53792, USA.
Background:
Vancomycin treatment of complicated Gram-positive infections is associated with laboratory monitoring, nephrotoxicity, and multiple daily dosing. Oritavancin, a lipoglycopeptide antibiotic with a once-weekly dosing strategy and similar but slightly broader spectrum of activity, presents several opportunities over vancomycin to improve compliance and convenience for the patient. Minimal real-world clinical and acquisition cost data in the inpatient setting and clinical data surrounding multiple dosing in the outpatient setting have limited oritavancin use despite its potential logistic advantages.
Objectives:
We describe inpatient and outpatient oritavancin administration, clinical outcomes, and economic impact.
Methods:
This was a single-center, retrospective case series of patients treated with at least one dose of oritavancin between May 2015 and September 2017 at an academic medical center in the USA. A simplified cost-avoidance analysis was conducted assuming the patient had a national health insurance plan and focused on hospital days prevented.
Results:
Seventy-five patients received oritavancin during the study period. The most common use of oritavancin was in patients with acute bacterial skin and skin structure infections (ABSSSI), defined as cellulitis, abscess or non-surgical wounds (n = 25, 33%), followed by surgical wound infections (n = 12, 16%) and osteomyelitis or septic arthritis (n = 10, 13%). Clinical cure or improvement was achieved in 68 patients (93.2%), while five patients (6.8%) failed treatment; adverse reactions were reported in nine patients (12%). Thirty-five patients received oritavancin as inpatients; 20 patients (57%) had at least one hospital day avoided due to inpatient oritavancin administration resulting in a total cost avoidance of US$343,654.
Conclusion:
In this series of 75 patients with Gram-positive infections, oritavancin treatment resulted in clinical cure or improvement in most patients, and was generally well tolerated. Inpatient administration may avoid costs and outpatient administration is a reasonable consideration for patients in which prolonged antibiotic therapy is necessary.
Insights
Oritavancin demonstrated high clinical cure rates for Gram-positive infections, offering a convenient once-weekly dosing alternative. This lipoglycopeptide antibiotic showed potential for cost avoidance in inpatient settings and is suitable for outpatient use.
Area of Science:
- Infectious Diseases
- Pharmacology
- Health Economics
Background:
- Vancomycin treatment for complicated Gram-positive infections involves intensive monitoring, risk of nephrotoxicity, and frequent dosing.
- Oritavancin, a lipoglycopeptide, offers a once-weekly dosing regimen with a similar, slightly broader spectrum, improving patient compliance and convenience.
- Limited real-world data on inpatient costs and outpatient efficacy have restricted oritavancin's adoption despite its logistical advantages.
Purpose of the Study:
- To evaluate the administration, clinical outcomes, and economic impact of oritavancin in both inpatient and outpatient settings.
- To assess the real-world effectiveness and safety of oritavancin for Gram-positive infections.
Main Methods:
- A single-center, retrospective case series included 75 patients treated with oritavancin from May 2015 to September 2017.
- A simplified cost-avoidance analysis focused on prevented hospital days for patients with national health insurance.
- Data collected included infection type, treatment outcomes, adverse events, and inpatient cost savings.
Main Results:
- Oritavancin was most frequently used for acute bacterial skin and skin structure infections (33%), surgical wound infections (16%), and osteomyelitis/septic arthritis (13%).
- Clinical cure or improvement was observed in 93.2% of patients; 12% reported adverse reactions.
- Inpatient oritavancin administration in 35 patients resulted in 20 instances (57%) of avoided hospital days, totaling US$343,654 in cost avoidance.
Conclusions:
- Oritavancin treatment led to successful clinical outcomes in the majority of patients with Gram-positive infections and was well-tolerated.
- Inpatient oritavancin administration demonstrated potential for significant cost savings by reducing hospital length of stay.
- Outpatient oritavancin is a viable option for patients requiring extended antibiotic therapy, enhancing convenience and compliance.
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