Cost-effectiveness of outpatient parenteral antibiotic therapy: a simulation modelling approach

Vargas-Palacios, A.; Meads, D. M.; Twiddy, M.; Murray, C. Czoski; Hulme, C.; Mitchell, E. D.; Gregson, A.; Stanley, P.; Minton, J.

Abstract

© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Objectives: In the UK, patients who require intravenous antimicrobial (IVA) treatment may receive this in the community through outpatient parenteral antimicrobial therapy (OPAT) services. Services include: IVA administration at a hospital outpatient clinic (HO); IVA administration at home by a general nurse (GN) or a specialist nurse (SN); or patient self-administered (SA) IVA administration following training. There is uncertainty regarding which OPAT services represent value for money; this study aimed to estimate their cost-effectiveness.Methods: A cost-effectiveness decision-analytic model was developed using a simulation technique utilizing data from hospital records and a systematic review of the literature. The model estimates cost per QALY gained from the National Health Service (NHS) perspective for short- and long-term treatment of infections and service combinations across these.Results: In short-term treatments, HO was estimated as the most effective (0.7239 QALYs), but at the highest cost (£973). SN was the least costly (£710), producing 0.7228 QALYs. The combination between SN and HO was estimated to produce 0.7235 QALYs at a cost of £841. For long-term treatments, SN was the most effective (0.677 QALYs), costing £2379, while SA was the least costly at £1883, producing 0.666 QALYs. A combination of SA and SN was estimated to produce 0.672 QALYs at a cost of £2128.Conclusions: SN and SA are cost-effective for short- and long-term treatment of infections, while combining services may represent the second-best alternative for OPAT in the UK.

Citation

Vargas-Palacios, A., Meads, D. M., Twiddy, M., Murray, C. C., Hulme, C., Mitchell, E. D., Gregson, A., Stanley, P., & Minton, J. (2017). Cost-effectiveness of outpatient parenteral antibiotic therapy: a simulation modelling approach. The journal of antimicrobial chemotherapy, 72(8), 2392-2400. https://doi.org/10.1093/jac/dkx123

• Journal Article Type: Article
• Acceptance Date: Mar 29, 2017
• Online Publication Date: May 15, 2017
• Publication Date: Aug 1, 2017
• Deposit Date: Dec 4, 2017
• Publicly Available Date: May 16, 2018
• Journal: Journal of Antimicrobial Chemotherapy
• Print ISSN: 0305-7453
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 72
• Issue: 8
• Pages: 2392-2400
• DOI: https://doi.org/10.1093/jac/dkx123
• Keywords: Pharmacology (medical); Pharmacology; Infectious Diseases
• Public URL: https://hull-repository.worktribe.com/output/484925
• Publisher URL: https://academic.oup.com/jac/article/72/8/2392/3827870
• Related Public URLs: http://eprints.whiterose.ac.uk/115732/
• Contract Date: Jan 2, 2018