Analisi retrospettiva dei consumi ospedalieri nelle infezioni batteriche acute di cute e struttura cutanea (ABSSSI): valutazione della riduzione
delle giornate di degenza e dei relativi costi organizzativi con l’impiego
di dalbavancina nell’Ospedale di Fermo
Carlo Livini, Walter Del Rosso, Massimo Fioretti
Introduction The early discharge strategy may improve patient and National Health Service convenience, leading to potential savings in inpatient days, reduction of costs and improvement in patients’ quality of life. Dalbavancin is a long-acting lipoglycopeptide antibiotic, active against gram-positive pathogens. The long plasma half-life allows, for treatment of acute bacterial skin and skin-structure infections (ABSSSI), the administration either as a one shot 30-min infusion or two 30-min infusions at day 1 and day 8.
The analysis is aimed to assess the organisational and economic impact of dalbavancin adoption in hospital setting in Italy.
Methods A retrospective observational analysis is performed on patients with ABSSSI, admitted to Fermo Hospital between 2017 and 2018. The potential saving obtained with dalbavancin was evaluated considering two different scenarios: a worst case scenario in which patients were hospitalised until full recovery and a best case scenario, in which patients eligible to early discharge, completed their treatment in an outpatient setting.
Results One hundred fifty-six patients with ABSSSI were hospitalized between 2017 and 2018, with a total of 2,156 days of hospitalization in two years. The early discharge using dalbavancin was associated with a reduction of inpatient days ranging from 136 to 240 in 2017 and from 239 to 310 in 2018, respectively in worst and best scenario. We estimated the average reduction of hospitalization with dalbavancin in 3 days. The economic evaluation showed a potential hospitalization costs reduction between € 281,250 (worst scenario) and € 412,500 (best scenario). The average savings remain above € 230,000 even considering the cost of dalbavancin therapy.
Conclusions Using dalbavancin for ABSSSI may facilitate an early discharge strategy leading to a substantial cost saving.
Key words: ABSSSI, gram-positive infection, dalbavancin, long-acting antibiotics, early discharge, cost saving, real word analysis