Transition of Care with Dalbavancin: a Successful Cost-Saving Stewardship Program through Decreased Length of Stay

BACKGROUND: A key part of our antimicrobial stewardship program (ASP) includes interdisciplinary collaboration to develop a transition of care plan for patients needing long-term antibiotics. Many of our challenging clinical scenarios involve inpatients, who do not qualify for intravenous antibiotics administered via home health agencies or skilled nursing facilities, with complicated skin and soft tissue structure (cSSTI), joint and bone infections. Their cost-of-care, driven mainly by prolonged length of stay (LOS), is high. For infections involving gram-positive bacteria treatment with dalbavancin, while an expensive antibiotic, posed a viable option for transitioning select patients for early discharge. METHODS: Retrospective review of cases was conducted for all patients administered dalbavancin at Deaconess Hospital from Dec 2015 to Jan 2017. Prior to drug administration patient cases required approval by ASP for appropriateness of treatment plan. Data collected included diagnosis/site of infection, organism, current IVDU, treatment plan (and if completed), inpatient and estimated total LOS, dalbavancin dosing regimen, and cost (drug and LOS). Overall cost savings was calculated by LOS savings ($1,000/day) minus cost of dalbavancin ($1,400/500mg vial). RESULTS: 17 patients (13 IVDUs) were administered dalbavancin: 8 for cSSTI, 8 for osteo/joint infections and 1 for bacteremia. 7 of 8 patients with cSSTI received either 1 or 1.5 gm of dalbavancin once; and 1 patient returned for weekly dosing to complete therapy. 3 of 8 patients with osteo/joint infections received a one-time dose to complete treatment; 4 returned for weekly dosing; and 1 patient was lost-to-follow-up. Only one patient, overall, was readmitted. Treatment was well tolerated and no complications were noted. Mean actual LOS (range) for patients with cSSTI was 11 (3–32) days; and with osteo/joint was 23 (13–36) days. Cost of dalbavancin was $68,600. Total LOS was decreased by 270 days. Overall savings were over $200,000. CONCLUSION: Findings were presented to pharmacy and hospital leadership as an example of a safe, effective, cost-saving ASP outcome. For every dollar spent on dalbavancin our hospital saved three dollars on cost-of-care related to decreased length of stay. DISCLOSURES: All authors: No reported disclosures.