288 Expediting Discharge in Acute Bacterial Skin and Skin ...€¦ · PowerPoint Presentation...

All ARMC inpatients that were administered oritavancin and/or vancomycin for ABSSSI between May

2017 and January 2018 were included in this retrospective evaluation. Patients were excluded if they

received oritavancin for reasons other then to expedite discharge.

Medical records were reviewed and data collection included demographics and past medical history

including previous skin infections and length of stay (LOS). Patients who returned to ARMC within 30

days of discharge were evaluated.

A financial analysis was performed for patients based on their DRG and reimbursement, employing

hospital specific expenditures provided by the ARMC finance department.

Data was analyzed utilizing fisher’s exact test, chi-square test or t-test as appropriate.

The primary endpoint was to determine the 30-day ABSSSI recurrence rate between treatment

arms for the selected population.

The secondary endpoints were to evaluate financial expenditures associated with utilization of

oritavancin as compared to vancomycin, and to assess for potential risk factors associated

with readmission.

Expediting Discharge in Acute Bacterial Skin and Skin Structure Infections: A Clinical and

Economic Comparison Between Vancomycin and Oritavancin in Hospitalized Patients Cristen Whittaker, Pharm.D., Pavan Ganapathiraju, DO, Ethan Nhan, Pharm.D., CACP,

Sandra Garrett, B.S.Pharm., MBA, Joseph Reilly, Pharm.D., BCGP, Manish Trivedi, MD

AtlantiCare Regional Medical Center, Pomona, N.J., U.S.A.

Objectives

Methods

Introduction

Results

Conclusion

Figure 3: Economic Evaluation of Oritavancin vs. Vancomycin Acute bacterial skin and skin structure infections (ABSSSI) have a large economic burden secondary to

prolonged hospitalizations and high rates of recurrent infections.

Oritavancin is a single-dose intravenous (IV) antibiotic for the treatment of ABSSSI proven to be non-

inferior to IV vancomycin in large comparative trials.1,2

Utilizing oritavancin rather than vancomycin, select inpatients may be discharged earlier in their

hospitalization with anticipated decreased infection recurrences and cost avoidance.

An appropriate use guideline was developed at AtlantiCare Regional Medical Center (ARMC) to help

identify candidates for expedited discharge with oritavancin.

This study evaluated outcomes of ARMC inpatients with ABSSSI who received either oritavancin to

expedite discharge or conventional therapy with IV vancomycin with oral antibiotics at discharge.

Utilizing oritavancin to expedite discharge in hospitalized patients appears to be an effective and

financially beneficial treatment for ABSSSI.

Although no risk factors for readmission or infection recurrence were identified as statistically

significant, IVDU, leaving against medical advice (AMA) at initial visit and a previous ED visit for the

same infection appear to be clinically significant risk factors for return.

Improvements in this initiative are ongoing with intentions of administering oritavancin earlier in each

hospitalization and to identify patients with risk factors for readmission. References:

1. Deck DH, et al. Infect Dis Ther. 2016 Sep;5(3):353-61. 2. Corey GR, et al. Clin Infect Dis. 2015 Jan 15;60(2):254-62.

Economic Evaluation of Oritavancin vs. Vancomycin

(n=101)

Patients Treated with Oritavancin (n=51)

Patients Treated with Vancomycin (n=50)

Average LOS:

3.3 Days

Average LOS:

5.6 Days

Inpatient Days Saved:

111.7 Days

$462,825 $770,000 Cost of Hospital

Admission: $2,750 / day

$137,700 Cost Of Oritavancin:

$2,700 / patient

$279,021 Average DRG

Reimbursement: $5,470 / patient

$0

Cost Avoidance By Utilizing Oritavancin:

$172,996

Cost for ARMC:

$321,504

Cost for ARMC:

$494,500

Patients with 30-Day Infection-Related

Readmission

2 Patients With Average LOS of 3 Days

(Range: 2-4 Days)

9 Patients With Average LOS of 4 Days

(Range: 1-7 Days)

$16,500 $99,000

Minimum Cost Avoidance for ARMC: $172,996 (Excluding Readmission Costs)

$275,500

288

Corresponding Author:

Cristen Whittaker, Pharm.D.

cristen.whittaker@atlanticare.org

Table 1: Baseline Characteristics (n=101)

Characteristic IV Oritavancin (n=51) IV Vancomycin (n=50) p-value

Age (Years) 47.4 ± 16.8 47.7 ± 13.1 0.926

Length of Stay (Days) 3.3 ± 1.9 5.6 ± 2.9 0.0001

Male Sex 30 (59%) 31 (62%) 0.833

Current IV Drug User 24 (47%) 14 (28%) 0.065

Same ABSSSI Treated Within

30-days Prior to Admission 19 (37%) 19 (38%) 0.999

Data is presented as no (%), or mean ± standard deviation

Table 2:Characteristics of Returning Patients (n=11)

Characteristic IV Oritavancin (n=2) IV Vancomycin (n=9) p-value

Age (Years) 73 ± 2.8 45.2 ± 14 0.0249

Initial Length of Stay (Days) 3 ± 0 5 ± 2 0.2079

Time to Readmission (Days) 20 ± 14 13 ± 11 0.4513

Length of Stay at Second Visit (Days) 3 ± 1.4 4 ± 2 0.5267

Re-Presentation with Bacteremia 0 3 (33%) 0.999

Re-Presentation with Osteomyelitis 0 2 (22%) 0.999

Re-Presentation with Gram Negative

Infection 2 (100%) 1 (11%) 0.054

Data is presented as no (%), or mean ± standard deviation

0 0

1

6

3

6

0

1

2

3

4

5

6

7

Current IV Drug User (p=0.182) Left AMA At Initial Presentation(p=0.999)

ED Visit Within Prior 30 Days ForSame Infection (p=0.999)

Nu

mb

er

of

Pa

tie

nts

Oritavancin (n=2)

Vancomycin (n=9)

Results

Figure 1: Primary Endpoint Results (n=101)

4%

96%

30-Day ABSSSI Recurrence: Oritavancin (n=51)

Recurrence (n=2) No recurrence (n=49)

18%

82%

30-Day ABSSSI Recurrence: Vancomycin (n=50)

Recurrence (n=9) No recurrence (n=41)

67%

67%

33%

50%

p-value:0.0279

Figure 2: Potential Risk Factors For Readmission (n=11)

Readmission Cost for Hospitalization Days