Cost-Savings Associated With Delayed Switch To Outpatient Antibiotic Regimen For Patients Requiring Daptomycin Therapy

BACKGROUND: Daptomycin is often preferred for treatment of Gram-positive infections requiring intravenous therapy in the outpatient setting due to convenient once-daily dosing and ease of laboratory monitoring. A key component of the outpatient parenteral antimicrobial therapy (OPAT) transition of care process is switching patients from their inpatient regimen, typically vancomycin, to daptomycin before discharge to assess tolerability. A medication utilization review identified that patients were changed to daptomycin earlier than necessary resulting in overutilization of a high cost medication, thus significantly increasing drug expenses when lower cost alternatives existed. The primary objective of this study was to evaluate the effectiveness of a pharmacist-driven intervention on the reduction of unnecessary inpatient daptomycin use for OPAT patients. METHODS: In May 2016, the antimicrobial stewardship committee instituted a restriction on daptomycin for a maximum of two inpatient doses prior to discharge in cases for which alternative agents were available. The OPAT pharmacist was responsible for ensuring the restriction was met. Daptomycin procurement expenses were obtained for eight months prior to the intervention to establish a baseline. Post-intervention data collection included monthly procurement expenses, number of patients receiving inpatient daptomycin, and number of doses administered. RESULTS: Pre-intervention daptomycin procurement expenses averaged $85,900 per month, which decreased by $25,000 per month post-intervention, resulting in estimated annual savings of $300,000. The number of patients receiving inpatient daptomycin (OPAT and non-OPAT) remained stable pre- and post-intervention at 43 and 41 per month, respectively. Lastly, the average number of inpatient doses administered in the pre- and post-intervention periods was 164 and 112, respectively. CONCLUSION: The results of this study demonstrate that clinical pharmacists can effectively limit inappropriate early switches to daptomycin in preparation for discharge to an OPAT program. Simple stewardship program interventions can ensure that the correct agents are utilized before and after discharge resulting in significant cost savings. DISCLOSURES: All authors: No reported disclosures.