Budget Impact and Financial Analysis of Outpatient Dalbavancin in an Urban, Non-Teaching, Community Hospital

Acute bacterial skin and skin structure infections (ABSSSI), diabetic foot infections (DFI), and osteomyelitis often require extended antimicrobial therapy courses. Dalbavancin's long half-life allows outpatient or emergency department (ED) management of patients not amenable to oral antimicrobials and/or outpatient infusion.

To provide a budget-impact analysis and real-world assessment of dalbavancin cost and reimbursement data, and model drug acquisition cost-avoidance compared to daptomycin and oral linezolid in outpatient and ED patients at our institution (New Jersey, USA).

All patients treated with dalbavancin in the ED or outpatient wound clinic during the one-year study period with available drug-specific reimbursement data were included. Wholesale acquisition costs were compared between dalbavancin, daptomycin, and oral linezolid. We conducted a regression analysis studying profit changes with patient weight, indication, drug-specific reimbursement, and treatment duration. We fitted a linear mixed-effects model and paired t-test to explore relationships between potential profit and various predictors while accounting for random effects of different indications. Paired t-tests were conducted evaluating potential profit and cost avoidance from the hospital and institutional pharmacy perspective associated with dalbavancin across treatment durations and indications.

Eighty-eight individual patient encounters were included in the final analysis. Treatment indications included ABSSSI (48.9%), DFI (33%), diabetic foot osteomyelitis (9%), osteomyelitis (6.8%), and septic arthritis (2.3%). An overall positive reimbursement of approximately US$3500 per patient per encounter was realized. Drug acquisition cost modeling demonstrated variable cost avoidance with dalbavancin compared to daptomycin or oral linezolid based on anticipated treatment duration. Average wholesale acquisition cost difference ranged from a potential loss of US$427.64 to a gain of US$12,557.94 and a loss of US$829.28 to possible gain of US$4370.32 compared to daptomycin and linezolid, respectively, based on treatment duration.

Outpatient dalbavancin utilization presents an opportunity to realize net positive reimbursement and minimize pharmacy drug acquisition costs. Our study suggests that dalbavancin utilization presents significant cost advantages over intravenous daptomycin in both short and long treatment durations and over oral linezolid in long durations.