Abstract
IntroductionOutpatient parenteral antimicrobial therapy (OPAT) is used to treat a wide range of infections, and is common practice in countries such as the USA and Australia. In the UK, national guidelines (standards of care) for OPAT services have been developed to act as a benchmark for clinical monitoring and quality. However, the availability of OPAT services in the UK is still patchy and until quite recently was available only in specialist centres. Over time, National Health Service (NHS) Trusts have developed OPAT services in response to local needs, which has resulted in different service configurations and models of care. However, there has been no robust examination comparing the cost-effectiveness of each service type, or any systematic examination of patient preferences for services on which to base any business case decision.Methods and analysisThe study will use a mixed methods approach, to evaluate patient preferences for and the cost-effectiveness of OPAT service models. The study includes seven NHS Trusts located in four counties. There are five inter-related work packages: a systematic review of the published research on the safety, efficacy and cost-effectiveness of intravenous antibiotic delivery services; a qualitative study to explore existing OPAT services and perceived barriers to future development; an economic model to estimate the comparative value of four different community intravenous antibiotic services; a discrete choice experiment to assess patient preferences for services, and an expert panel to agree which service models may constitute the optimal service model(s) of community intravenous antibiotics delivery.Ethics and disseminationThe study has been approved by the NRES Committee, South West—Frenchay using the Proportionate Review Service (ref 13/SW/0060). The results of the study will be disseminated at national and international conferences, and in international journals.
Highlights
Outpatient parenteral antimicrobial therapy (OPAT) is used to treat a wide range of infections, and is common practice in countries such as the USA and Australia
There are five inter-related work packages: a systematic review of the published research on the safety, efficacy and cost-effectiveness of intravenous antibiotic delivery services; a qualitative study to explore existing outpatient parenteral antimicrobial therapy (OPAT) services and perceived barriers to future development; an economic model to estimate the comparative value of four different community intravenous antibiotic services; a discrete choice experiment to assess patient preferences for services, and an expert panel to agree which service models may constitute the optimal service model(s) of community intravenous antibiotics delivery
▪ While not a clinical trial, this study offers insights into the cost-effectiveness of OPAT services, and provides evidence on which decisions relating to the conduct of any future randomised controlled trial could be based
Summary
Outpatient parenteral antimicrobial therapy (OPAT) is used to treat a wide range of infections, and is common practice in countries such as the USA and Australia. OPAT services in the UK started in the 1990s, and were limited to specialist centres, but services have recently began to expand, as the benefits to patients and the healthcare system were recognised.[2] Several countries, including the UK have developed national guidelines (standards of care) for OPAT services to act as a benchmark for clinical monitoring and quality.[2 8 9] To support the development of such services in the UK, the British Society of Antimicrobial Chemotherapy (BSAC) have sponsored the development of a toolkit which clinicians can use to develop a business case for their service This toolkit contains SWOT analyses for each service type, but does not favour any particular model of service design.[2] there has been no robust examination comparing the cost-effectiveness of each service type, or any systematic examination of patient preferences for services on which to base any business case decision. Further barriers to the development of OPAT services are a lack of any specific funding system for this in the National Health Service (NHS), combined with the complexity of existing charging mechanisms.[10]
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