Inpatient Cost Avoidance and Uncompensated Labor Associated With Different Outpatient Parenteral Antimicrobial...

Outpatient parenteral antimicrobial therapy (OPAT) decreases length of stay and inpatient costs while benefiting patients. However, costs in the ambulatory setting are poorly quantified. To address this gap, we examined both inpatient costs avoided and uncompensated labor associated with OPAT delivered via 3 administration models: self-administration (S-OPAT), home care agencies/hemodialysis centers (HH-OPAT), and skilled nursing facilities (SNF-OPAT).

The length and type of treatment and postdischarge nonbillable encounters were reviewed via the electronic health record for all adult patients admitted to a large urban hospital and discharged on OPAT during two 3-month periods. Average daily inpatient care costs for Texas state hospitals and antibiotic wholesale acquisition costs were used to estimate OPAT costs and savings. Antibiotics with different formulations were converted to equivalent daily doses and their corresponding costs were averaged to estimate a daily cost.

Among 342 patient records examined during the study periods, which accounted for 8656 inpatient days avoided, there were 211.1 nonbillable encounters per 100 patient-days of OPAT for patients discharged in SNF-OPAT, 9.1 in HH-OPAT, and 6.4 in S-OPAT (P = .028). The estimated cost avoided per 100 patient-days was $376 400 or approximately $5 430 197 per month.

A substantial burden of uncompensated labor was associated with all OPAT modalities; however, coordinating care with skilled nursing facilities was significantly more demanding when adjusted for days of OPAT. All OPAT models generated significant institutional savings, which are typically overestimated as they fail to account for the uncompensated support provided by the ambulatory care staff.