Objectives

Emergency department (ED) patients with cellulitis requiring intravenous antibiotics may be treated via outpatient parenteral antibiotic therapy (OPAT) as opposed to hospitalization. The primary objective was to compare healthcare costs for the following strategies: community intravenous antibiotics with referral to an OPAT clinic operated by infectious disease specialists (‘OPAT clinic’ strategy); community intravenous antibiotics with return to ED if necessary (‘return to ED’ strategy); and hospital admission.

Methods

Using a hospital administrative database, we conducted a cost analysis using patient-level data of adult cellulitis patients presenting to two tertiary care EDs and were treated with intravenous antibiotics in one of three ways: OPAT clinic strategy; return to ED strategy; and hospital admission. Costs were estimated from Canada’s publicly funded health system perspective. The primary outcome was the mean total cost (2015 CAD) per patient for each treatment strategy. A generalized linear model was performed to adjust for baseline characteristics, including age, sex and comorbidities.

Results

A total of 808 patients met inclusion criteria: OPAT clinic strategy (N = 341); return to ED strategy (N = 228) and hospital admission (N = 239). The mean total cost of care for the treatment strategies were: OPAT clinic: $2170 (95% CI $1905–$2436); return to ED: $1493 (95 %CI $1264–$1722); and hospital admission: $10,145 (95% CI $8668–$11,622). Results from the regression analysis suggested that the OPAT clinic strategy was associated with a cost-saving of $7394 (95% CI $6154–$8633, p < 0.001) compared to hospital admission and an increased cost of $651 (95% CI $367–$935, p < 0.001) when compared to the return to ED approach.

Conclusions

This is the first Canadian study that compares the cost of different OPAT strategies for cellulitis patients. While both OPAT strategies are safe and far less costly than hospital admission, our findings suggest that a dedicated OPAT clinic for patients with cellulitis is more expensive than the return to ED strategy.

中文翻译：

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急诊室蜂窝织炎患者的门诊肠外抗生素治疗 (OPAT) 和住院治疗策略：成本分析

目标

急诊科 (ED) 需要静脉注射抗生素的蜂窝织炎患者可以通过门诊肠外抗生素治疗 (OPAT) 进行治疗，而不是住院治疗。主要目标是比较以下策略的医疗保健成本：社区静脉注射抗生素与转诊到由传染病专家运营的 OPAT 诊所（“OPAT 诊所”策略）；社区静脉注射抗生素，必要时返回 ED（“返回 ED”策略）；和住院。

方法

使用医院管理数据库，我们使用在两个三级护理 ED 就诊并通过以下三种方式之一接受静脉抗生素治疗的成人蜂窝织炎患者的患者水平数据进行了成本分析： OPAT 临床策略；回归 ED 策略；和住院。费用是从加拿大公共资助的卫生系统的角度估算的。主要结果是每种治疗策略的每位患者的平均总成本（2015 加元）。进行广义线性模型以调整基线特征，包括年龄、性别和合并症。

结果

共有 808 名患者符合纳入标准：OPAT 临床策略（N  = 341）；返回 ED 策略 ( N  = 228) 和住院 ( N  = 239)。治疗策略的平均总护理费用为： OPAT 诊所：2170 美元（95% CI 1905-2436 美元）；返回 ED：$1493 (95 %CI $1264–$1722)；住院费用：10,145 美元（95% CI 8668-11,622 美元）。回归分析的结果表明，与住院相比，OPAT 诊所策略可节省 7394 美元（95% CI 6154-8633 美元，p  < 0.001），成本增加 651 美元（95% CI 367-935 美元，p  < 0.001) 与返回 ED 方法相比。

结论

这是第一个比较蜂窝组织炎患者不同 OPAT 策略成本的加拿大研究。虽然这两种 OPAT 策略都是安全的，而且成本远低于入院，但我们的研究结果表明，为蜂窝织炎患者开设专门的 OPAT 诊所比返回 ED 策略更昂贵。