Analisi di minimizzazione dei costi del trattamento delle infezioni batteriche acute di cute e struttura cutanea a livello del sito chirurgico in pazienti sottoposti ad intervento cardiochirurgico
Marco Barbieri, Paolo Bigliano, Diego Barilà, Alberto Clerici, Mauro Rinaldi, Giovanni Di Perri, Francesco G. De Rosa
Background: Dalbavancin, a lipoglycopeptide antibiotic agent that is active against gram-positive pathogens, has a long plasma half-life, allowing for one single dosing (once shot) or once a week for 2 weeks for treatment of acute bacterial skin and skin-structure infections (ABSSSI). The objective of this analysis was to assess whether the use of dalbavancin would lead to a reduction of hospital costs for inpatients with ABSSSI after cardiosurgery compared to other antibiotic treatments.
Methods: We retrospectively reviewed 35 patients with definite, probable or possible ABSSSI after surgery in a Cardiac Surgery Department of the “Città della Salute e della Scienza” hospital in Turin during year 2014. Patients received several antibiotic treatments, including linezolid, vancomycin, daptomycin, tigecycline and teicoplanin. For each patient, we estimated whether the use of these antibiotic therapies increased the LOS (Length Of Stay) in cardiac surgery ward, namely whether they could have discharged earlier (at home or in a less expensive ward) with the use of dalbavancin. The cost savings associated with this potential reduction in LOS were estimated. Costs of each antibiotic option and laboratory costs were also considered. Unit costs and resource use were mainly taken from the internal hospital costs or from national tariffs, when not available. Univariate sensitivity analyses were performed on key parameters.
Results: The use of dalbavancin was associated with cost savings ranging from approximately € 3,200 compared to vancomycin to € 4,700 compared to daptomycin. Savings were mainly due to a reduction in LOS estimated equal to 2.34 days. Sensitivity analyses corroborated the base case results, and dalbavancin remained cost saving in every scenario.
Conclusions: Dalbavancin has the potential of being a cost saving option compared to other commonly used antibiotic therapies from a hospital perspective due to the reduction in LOS. Future studies with a larger number of patients treated with dalbavancin may confirm these findings.
Key words: Dalbavancin, ABSSSI, cost-minimisation, length of stay, cardiosurgery