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Overview of economically recommended strategies
Source publication
This is the seventeenth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. This chapter analyses economic aspects of...
Context in source publication
Context 1
... parameters such as cost-effectiveness or costs per quality-adjusted year of age (Cost/QALY) are not considered, since these considerations do not play a major role in German-speaking countries and are only used in some English-speaking countries to decide whether or not certain medicines should be reimbursed. The aim of this text is to give readers a quick overview of economically advisable strategies in the form of a table, which in addition to the strategies also contains a level of recommendation in order to decide which of them should be used systematically (see Table 1). The selection of the antibiotic at the beginning of treatment -especially in critically ill patients -determines the clinical and economic outcome to a high degree. ...Similar publications
Introduction
Methicillin-resistant Staphylococcus aureus (MRSA) has a high mortality and requires effective treatment with anti-MRSA agents such as vancomycin (VCM). Management of the efficacy and safety of VCM has been implemented with the assignment of pharmacists in hospital wards and the establishment of teams related to infectious diseases. Ho...
Citations
... This change of administration route is possible since some oral antimicrobials have reliable pharmacokinetic profiles that achieve serum levels similar to those achieved by the intravenous drug. 8,9 Hence, it is essential to create institutional protocols for antimicrobial ST, which includes eligibility criteria, as well as a bioavailability table comparing IV and PO formulations. 7,10 Thus, this study aimed to analyze the impact of pharmacoeconomic strategies and antimicrobial stewardship programs, beyond switching the drug administration route, in waste generation and management in a university hospital. ...
... 14 The ideal scenario is a short intravenous therapy, for 2-3 days, followed by the change to oral therapy until the end of treatment time in cases of mild to moderate infections. 9 For the safe change of route of administration the patient must present clinical improvement, be hemodynamically stable, afebrile, and with a count of leukocytes within the normal range, have good oral intake capacity, have a functioning gastrointestinal tract, and an oral antimicrobial with adequate spectrum of action must be available. 6 Although the ST relationship was not evaluated in this study before the existence of the protocol, this practice gradually increased over the 3 years analyzed. ...
Background:
The aim of this study was to evaluate the impact of Switch Therapy of antimicrobials on cost reduction (pharmacoeconomic analysis) and hospital waste generation by switching from intravenous to oral therapy. This is a cross-sectional, observational, and retrospective study.
Methods:
Data from 2019, 2020, and 2021, provided by the Clinical Pharmacy Service of a teaching hospital in the interior of Rio Grande do Sul, were analyzed. The variables analyzed were intravenous and oral antimicrobials, frequency, duration of use, and total treatment time according to institutional protocols. An estimate of the amount of waste not generated from the change of administration route was calculated by weighing the kits using a precision balance in grams.
Results:
During the analyzed period, 275 Switch Therapy of antimicrobials were performed, resulting in US$ 55,256.00 of savings. The main antimicrobial classes that underwent changes were Cephalosporins (25.1%), Penicillins (22.55%), and Quinolones (17.45%). Changing from intravenous to oral therapy avoided the generation of 170,631 grams of waste, including needles, syringes, infusion bags, equipment, reconstituted solution bottles, and medication.
Conclusions:
The change from intravenous to oral route of antimicrobials is safe for the patient, economically effective, and significantly reduces waste generation.
... Of these, all but two of them (IV dalbavancin and oral linezolid) must be administered via daily or twice daily IV infusion, and some, like vancomycin, necessitate therapeutic blood monitoring to ensure drug levels stay within the therapeutic range. 8 IDENTIFYING PATIENTS WHO COULD BE SENT HOME FROM HOSPITAL WITH ANTIBIOTIC TREATMENT According to Wilke, "one in three patients with an ABSSSI could be eligible for earlier discharge as a rule of thumb." Indeed, a multicentre, multicountry study of hospital inpatients with MRSA found that 37.9% could potentially be eligible for early discharge if eligibility criteria regarding infection and clinical stability were met. ...
Acute bacterial skin and skin structure infections (ABSSSI) can require long periods of antibiotic therapy. If an ABSSSI is treated while a person is in hospital, this may lead to an extended hospital stay of days or even weeks, even if the patient is in a stable enough medical condition to be discharged to their home environment. As such, inpatient treatment of an ABSSSI can incur high costs for the hospital and tie up beds that could be used for other patients. Michael Wilke from Inspiring-health GmbH, Munich, Germany, and the Medical School Hamburg, Germany, discussed with the EMJ how early discharge may be viable for patients who are medically stable and can either return to the hospital for daily treatment with intravenous (IV) infusions or are able to, reliably, take oral antibiotics. Also available are the long-acting antibiotics oritavancin and dalbavancin. The latter is administered only once via IV infusion. While the cost per dose of dalbavancin is more expensive than most oral or daily/twice daily IV antibiotic regimens, its use can facilitate early discharge, leading to reduced hospital stays and offset cost savings. Due to the administration schedule, the use of long-acting antibiotics circumvents issues with daily medication adherence.
Hospitalisation rates for acute bacterial skin and skin structure infection (ABSSSI) are rising and represent a large pharmacoeconomic burden as treatment may involve an extended number of days of antibiotic therapy. This article first aims to provide a review of treatment challenges associated with ABSSSIs in both hospital and outpatient settings, and shows that while more traditionally treatment has been conducted in a hospital setting, for a number of patients, a variety of considerations, including pharmacoeconomics, infection control, and patient preference, has led to the development of recommendations to assess the eligibility of patients for early discharge from hospital to complete their antibiotic regimen in the outpatient setting. However, such patients require monitoring for drug adherence to oral regimens or complications associated with daily intravenous administration, such as injection site reactions and infection. This review also focuses on one of a number of new antibiotics for ABSSSI, dalbavancin, as the long-acting glycopeptide with the most clinical experience to date. This antibiotic has been shown to be as effective as a daily/twice daily regimen with similar safety profiles. Health economic analysis of dalbavancin is also presented. It has shown that in some, though not all, clinical settings a reduction in the overall treatment cost is evident as, despite a higher medication cost, the lower hospitalisation time can lead to greater cost savings. In conclusion, while the burden of ABSSSI is rising, new treatment options provide additional therapeutic choice, although pharmacoeconomic considerations might limit use in some cases.
India has been titled the capital of antimicrobial resistance in the world with the centre for disease dynamics, economics and policy (CDDEP) predicting two million deaths in India by 2050. As per the World Health Organisation’s global priority pathogen list of 2017, methicillin resistant Staphylococcus aureus (MRSA) has been classified as a ‘high priority’ pathogen due to its association with increased mortality rate, rising prevalence of resistance and increased burden on healthcare settings. A recent report by Indian Council of Medical Research signifies the exponential rise in the prevalence of MRSA in India, from 29% in 2009 to 39% in 2018. Serious MRSA infections are commonly associated with poor clinical outcomes coupled with increased hospitalisation stay and cost. Therefore, early identification and appropriate empiric treatment of MRSA plays a crucial role in healthcare settings. However, the constant rise in multi-drug resistance to the currently available anti-MRSA agents as well as their compromised safety profile limits its clinical use to manage severe MRSA infections. This review article explores the implications of severe MRSA infections and inappropriate empirical therapy on the clinical as well as economic outcomes. In addition, it also highlights limitations of the currently available anti-MRSA agents and the need for newer agents to manage multi drug resistant (MDR) gram positive infections.
