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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.
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