Evaluation of Dalbavancin and Oritavancin as Cost-Effective Treatments of Acute Bacterial Skin and Skin Structure Infections in Hospitalized Patients

BACKGROUND: Acute bacterial skin and skin structure infections (ABSSSI) are a challenging medical problem associated with high health care costs. Dalbavancin and oritavancin are approved for treatment of ABSSSI and, due to their long half-life, are dosed as a one-time infusion. These agents may make it possible to allow for earlier discharge and reduce health care costs without compromising efficacy. METHODS: Retrospective chart review was performed for patients discharged from Abbott Northwestern Hospital (ANW) with primary diagnosis of skin and soft-tissue infection between October 1, 2015 and September 30, 2016. Inclusion and exclusion criteria were approved by ANW Antimicrobial Stewardship Committee and used to retrospectively identify potential candidates for oritavancin or dalbavancin. Retrospective cost-analysis was performed to assess potential cost savings with the use of dalbavancin or oritavancin instead of the traditional antibiotic therapy that was used. Financial impact was assessed taking into consideration potential cost savings and additional expenses with the use of dalbavancin or oritavancin. Data are presented as mean ± standard deviation. Statistical comparison between actual and predicted length of hospital stay was performed using paired t-test. P < 0.05 was considered statistically significant. RESULTS: In total, 294 admissions were identified. Eight patients met the selection criteria with the majority being intravenous drug users. Actual length of stay of candidates for dalbavancin or oritavancin was 4.3 ± 2.8 days. Predicted length of hospital stay if dalbavancin or oritavancin were used was 3.0 ± 1.9 days (P = 0.03 vs. actual length of stay). The use of dalbavancin or oritavancin may have prevented four readmissions, two peripherally inserted central catheter insertions, and the use of daptomycin in one patient. Despite the potential cost savings, the use of dalbavancin or oritavancin would result in an additional cost to ANW by an estimate of $937 to $20,107 a year. CONCLUSION: Dalbavancin or oritavancin may have been used in a small proportion of admissions (3%) with skin and soft-tissue infection as primary diagnosis. The high cost of dalbavancin and oritavancin offset any potential cost savings resulting in additional costs to ANW estimated to be up to $20,000 a year. DISCLOSURES: All authors: No reported disclosures.