PDG8 Economic Burden of Patients Treated with Dalbavancin in a Spanish Hospital: ECODAL Analysis

Abstract

The pharmacokinetic profile of dalbavancin (long half-life) allows an early discharge of hospitalized patients requiring intravenous antibiotic therapy ensuring therapeutic compliance. A hypothesis would be that outpatient's treatment helps offset the hospitalization cost associated with the use of standard IV treatment. Objective was to assess the economic burden of dalbavancin treated patients in a Spanish hospital setting. Single center observational retrospective post-hoc analysis based on electronic medical records of dalbavancin treated patients in 2018. Variables: baseline patient characteristics, hospitalization characteristics, drug treatment and concomitant therapy, treatment related adverse events, and direct costs (hospital care, specialized care, medical staff, nursing staff, drugs, tests, and equipment), and costs associated with re-admission; all these costs were obtained from the hospital (Hospital Pharmacy and Analytical Accounting departments). Robustness of results was validated by individual bootstrap analysis. Thirty-four dalbavancin treated patients in 2018 were included; mean age 57.88 and 70.6% men. Main indications were: outpatient management 68% (n=23), and 32% for predicted poor adherence, such as parenteral drug users (n=5). The main syndromes included: infective endocarditis (29%) and 47% of the infections were bacteremic; 50% of the infections were caused by Staphylococcus aureus (23.5% SARM). Direct costs are statistically significant for prolonged outpatient treatment, patients with baseline respiratory morbidity, and the use of dalbavancin as a second or more line treatment. The mean accumulative cost was 23,340,28€/patient, being the greatest expenditure in hospital stay, mean 28.56 days and 7,983.46€, and interventions, 8,407.98€. Without dalbavancin, this cost would have been increased in 9,745.56€ due to longer hospital stays, 47.41 additional days. There were no costs associated to the management of dalbavancin’s adverse events. Dalbavancin cost is compensated by a decrease in the length of hospital stay, and 30% total costs reduction. In 2018, dalbavancin could have avoided 1.612 hospital stay days.