Skip to main content

Advertisement

Springer Nature Link
Log in

Cost Analysis of an Adult Outpatient Parenteral Antibiotic Therapy (OPAT) Programme

A Canadian Teaching Hospital and Ministry of Health Perspective

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Background: Outpatient parenteral antibiotic therapy (OPAT) programmes have become prevalent over the past 2 decades. From the US perspective, these programmes have been shown to reduce healthcare costs. No comprehensive analysis has been published from the Canadian perspective.

Objective: To describe a Canadian OPAT programme for the 3-year period since its inception and to conduct a treatment cost analysis.

Design and methods: Demographics and resource utilisation data (health professional labour, laboratory and diagnostic tests, antimicrobials, delivery, home nursing care, catheters and catheter placement) were prospectively collected for enrollees in the OPAT programme over the evaluation period. Avoided hospital resource utilisation was estimated via retrospective chart review by the investigators. Costs were retrospectively assigned to each resource and total cost avoidance by the OPAT programme was determined from each perspective.

Perspective: A teaching hospital and a provincial Ministry of Health (MOH).

Main outcome measures and results: 140 treatment courses were initiated for 117 adult patients (mean age 54 years) who were enrolled into the programme. Mean pre-OPAT length of hospital stay was 12 days, and mean OPAT duration was 22.5 days. Bone/joint (39%), skin and soft tissue (16%), cardiac (13%) and respiratory tract (12%) infections were the most common infections managed. The most commonly used antimicrobials were vancomycin (29%), cloxacillin ± gentamicin (22%) and ceftriaxone ± gentamicin (11%). 85%of enrollees successfully completed their planned antimicrobial treatment regimens. Premature discontinuation of antimicrobial therapy for various reasons occurred in the remaining 15% of courses. The mean cost per treatment course of OPAT was 1910 Canadian dollars ($Can) from the hospital perspective and $Can6326 from the MOH perspective. Assuming that patients would have otherwise completed their antimicrobial therapy in hospital, the mean cost per treatment course was estimated to be $Can14 271. The overall cost avoidance of the OPAT programme was $Can1 730 520 (hospital perspective) and $Can1 009 450 (MOH perspective) over the 3-year assessment period. Sensitivity analyses revealed the results to be robust to plausible changes.

Conclusions: This analysis supports the premise that an adult OPAT programme can substantially reduce healthcare costs in the Canadian healthcare setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Stiver HG, Telford GO, Mossey JM, et al. Intravenous antibiotic therapy at home. Ann Intern Med 1978; 89: 690–3

    PubMed  CAS  Google Scholar 

  2. Poretz DM. Home intravenous antibiotic therapy. Clin Geriatr Med 1991; 7: 749–63

    PubMed  CAS  Google Scholar 

  3. Poretz DM, Eron LJ, Goldenberg RI, et al. Intravenous antibiotic therapy in an outpatient setting. JAMA 1982; 248: 336–9

    Article  PubMed  CAS  Google Scholar 

  4. Grayson ML, Silvers J, Turnidge J. Home intravenous antibiotic therapy. A safe and effective alternative to inpatient care. Med J Aust 1995; 162: 249–53

    PubMed  CAS  Google Scholar 

  5. Tice AD. Experience with a physician-directed, clinic-based program for outpatient parenteral antibiotic therapy in the USA. Eur J Clin Microbiol Infect Dis 1995; 14: 655–61

    Article  PubMed  CAS  Google Scholar 

  6. Montalto M. Patients’ and carers’ satisfaction with hospital-in-the- home care. Int J Qual Health Care 1996; 8: 243–51

    Article  PubMed  CAS  Google Scholar 

  7. Craven PC. Treating bone and joint infections with teicoplanin: hospitalization vs. outpatient cost issues. Hosp Formul 1993; 28 Suppl. 1: 41–5

    PubMed  Google Scholar 

  8. Williams DN. Safety, efficacy, and cost savings in an outpatient intravenous antibiotic program. Clin Ther 1993; 15: 169–79

    PubMed  CAS  Google Scholar 

  9. Chamberlain TM, Lehman ME, Groh MJ, et al. Cost analysis of a home intravenous antibiotic program. Am J Hosp Pharm 1988; 45: 2341–5

    PubMed  CAS  Google Scholar 

  10. Allen R. Cost-effectiveness issues for home i.v. therapy in the United States. Hosp Formul 1993; 28 Suppl. 1: 37–40

    PubMed  Google Scholar 

  11. Thickson ND. Economics of home intravenous services. Pharmacoeconomics 1993; 3: 220–7

    Article  PubMed  CAS  Google Scholar 

  12. Cote D, Oruck J, Thickson N. A review of the Manitoba home i.v. antibiotic program. Can J Hosp Pharm 1989; 42: 137–41

    PubMed  CAS  Google Scholar 

  13. Stiver G, Wai A, Chase L, et al. Outpatient intravenous antibiotic therapy: the Vancouver Hospital experience. Can J Infect Dis 2000; 11 Suppl. A: 11A-4A

    Google Scholar 

  14. Larson LN. Cost determination and analysis. In: Bootman JL, Townsend RJ, McGhan WR, editors. Principles of pharmacoeconomics. 2nd ed. Cincinnati (OH): Harvey Whitney Books Co., 1996: 44–59

    Google Scholar 

  15. British Columbia Medical Association guide to fees. Vancouver (BC): British Columbia Medical Association, 1998

  16. Jewesson PJ. Pharmaceutical, pharmacokinetic and other considerations for intravenous to oral stepdown therapy. Can Infect Dis J 1995; 6 Suppl. A: 11A-6A

    Google Scholar 

Download references

Acknowledgements

The authors thank Lynn Chase, Ruth Nicol, Barb Ferreira, Carole Leong and Sally Tomlinson, Clinical Nurse Educators, Infusion Program, for their commitment to the exemplary care of patients enrolled in the OPAT programme. Our thanks as well to Dr Grant Stiver and the balance of the Infectious Diseases Division for their ongoing contributions to the infectious disease management of these patients. Finally, we thank Dr Peter Zed, who conducted a preliminary review of the OPAT programme while a student in the Doctor of Pharmacy Program at the University of British Columbia.

Author information

Authors and Affiliations

  1. Vancouver Hospital and Health Sciences Centre and Faculty of Pharmaceutical Sciences, University of British Columbia, 855 W 12th Avenue, Vancouver, V5Z 1M9, British Columbia, Canada

    Amy O. Wai, Luciana Frighetto, Carlo A. Marra, Emily Chan &  Peter J. Jewesson

Authors
  1. Amy O. Wai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luciana Frighetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo A. Marra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emily Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter J. Jewesson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter J. Jewesson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wai, A.O., Frighetto, L., Marra, C.A. et al. Cost Analysis of an Adult Outpatient Parenteral Antibiotic Therapy (OPAT) Programme. Pharmacoeconomics 18, 451–457 (2000). https://doi.org/10.2165/00019053-200018050-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-200018050-00004

Keywords