Abstract
The use of long-acting lipoglycopeptides (LaLGPs) in serious, deep-seated infections is of increasing interest. The purpose of this study is to evaluate the economic and clinical utility of LaLGPs in patients requiring protracted antibiotic courses who are not ideal candidates for oral transition or outpatient parenteral antibiotic therapy (OPAT). This is a retrospective, observational, matched cohort study of adult patients who received a LaLGP. Patients were matched 1:1 to those who received standard of care (SOC). Cost effectiveness was evaluated as total healthcare-related costs between groups. Clinical failure was a composite endpoint of mortality, recurrence, or need for extended antibiotics beyond planned course within 90 days of initial infection. There was no difference in clinical failure between the two cohorts (22% vs. 30%; p = 0.491). Six patients in the SOC cohort left against medical advice (AMA) prior to completing therapy. Among those who did not leave AMA, receipt of LaLGPs resulted in a decreased hospital length of stay by an average of 13.6 days. The average total healthcare-related cost of care was USD 295,589 in the LaLGP cohort compared to USD 326,089 in the SOC cohort (p = 0.282). Receipt of LaLGPs may be a beneficial treatment option for patients with deep-seated infections and socioeconomic factors who are not candidates for oral transition or OPAT.
Highlights
Dalbavancin and oritavancin are intravenous (IV), long-acting lipoglycopeptides (LaLGPs) with extended half-lives and broad-spectrum of coverage against gram-positive bacteria, including methicillin-resistant staphylococcus aureus (MRSA) [1]
Dalbavancin is approved by the United States Food and Drug Administration (FDA) for acute bacterial skin and skin structure infections (ABSSSIs) as a 1500 mg single dose regimen, or a two-dose regimen of 1000 mg initially followed by 500 mg one week later [2]
The cost effectiveness for this indication is debatable; the pharmacokinetic (PK) and dosing advantages offered by LaLGPs have increased interest in use in off-label conditions including serious, deep-seated infections requiring protracted antibiotic courses
Summary
Dalbavancin and oritavancin are intravenous (IV), long-acting lipoglycopeptides (LaLGPs) with extended half-lives and broad-spectrum of coverage against gram-positive bacteria, including methicillin-resistant staphylococcus aureus (MRSA) [1]. Dalbavancin concentrations 2 weeks post a 1000 mg IV dose were sustained well above the minimal inhibitory concentration (MIC) for Staphylococcus aureus in both bone and serum [5]. A PK model of a 2-dose, 1500 mg IV once weekly regimen demonstrated sustained bone and serum concentrations above pharmacodynamic (PD) targets for up to 8 weeks [5]. These findings suggest LaLGPs achieve sufficient concentrations in deep-seated areas and may be an effective treatment option for such infections, rather than solely for use in ABSSIs
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