RESUMO
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). METHODS: Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. RESULTS: Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. CONCLUSION: Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.
Assuntos
Assistência Ambulatorial/métodos , Anti-Infecciosos/administração & dosagem , Árvores de Decisões , Programas Nacionais de Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Anti-Infecciosos/economia , Brasil , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Hospitais Universitários/economia , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Adulto JovemRESUMO
INTRODUCTION: Outpatient parenteral antimicrobial therapy (OPAT) consists of providing antimicrobial therapy by parenteral infusion without hospitalization. A systematic review was performed to compare OPAT and hospitalization as health care modalities from an economic perspective. Areas covered: We identified 1455 articles using 13 electronic databases and manual searches. Two independent reviewers identified 35 studies conducted between 1978 and 2016. We observed high heterogeneity in the following: countries, infection site, OPAT strategies and outcomes analyzed. Of these, 88% had a retrospective observational design and one was a randomized trial. With respect to economic analyses, 71% of the studies considered the cost-consequences, 11% cost minimization, 6% cost-benefit, 6% cost-utility analyses and 6% cost effectiveness. Considering all 35 studies, the general OPAT cost saving was 57.19% (from -13.03% to 95.47%). Taking into consideration only high-quality studies (6 comparative studies), the cost saving declined by 16.54% (from -13.03% to 46.86%). Expert commentary: Although most studies demonstrate that OPAT is cost-effective, the magnitude of this effect is compromised by poor methodological quality and heterogeneity. Economic assessments of the issue are needed using more rigorous methodologies that include a broad range of perspectives to identify the real magnitude of economic savings in different settings and OPAT modalities.
Assuntos
Assistência Ambulatorial/economia , Anti-Infecciosos/administração & dosagem , Infecções/tratamento farmacológico , Anti-Infecciosos/economia , Análise Custo-Benefício , Humanos , Infecções/economia , Infusões Parenterais , Pacientes Ambulatoriais , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Background: Childrens hospitalization for intravenous antibiotic treatment has been replaced in developed countries and in some Chilean centers to outpatient intravenous therapy (OPAT). Aim: To compare the effectiveness, safety and cost of OPAT versus inpatient care. Patients andMethods: Prospective cohort study in children (2 months-5 years) with febrile urinary tract infection (UTI) attended at two public Chilean hospitals: outpatient cohort and inpatient cohort. Between November of 2009-2010, 111 children were enrolled in OPAT and between January 2010-June 2011, 81 children were hospitalized. Demographic data, costs and parental care, response to treatment, adverse events and complications were registered. Results: There was no difference in the effectiveness of both treatments (100% in OPAT and 98.6% in inpatient cohort, p: 0.41). Adherence to OPAT was 100%. Prevalence of adverse events was higher in inpatient cohort (76.3% versus 16.2%, p < 0.01). The average direct cost was four times higher in inpatients, mainly due to bed-day cost. Indirect cost was similar in both groups. There were more days of absence from work and care centers in inpatients (p: 0.017, p: 0.045 respectively). Conclusion: OPAT for febrile UTI was equally effective, safer and significantly less expensive than inpatient care. OPAT represents a recommended intervention for pediatric services of Chilean public hospitals.
Introducción: La hospitalización de niños para tratamiento antimicrobiano intravenoso, ha sido reemplazada en países desarrollados y en algunos centros chilenos por el tratamiento antimicrobiano intravenoso ambulatorio (TAIA). Objetivo: Comparar efectividad, seguridad y costos de TAIA versus hospitalizado. Pacientes y Métodos: Se efectuó un estudio de cohorte prospectiva en niños (2 meses-5 años) con infección urinaria (ITU) febril atendidos en dos hospitales públicos chilenos: una cohorte ambulatoria y otra hospitalizada. Entre noviembre 2009 y 2010, se enrolaron 111 niños en TAIA y entre enero 2010-junio 2011, 81 niños hospitalizados. Se registraron datos demográficos, gastos de atención y de los padres, respuesta al tratamiento, eventos adversos y complicaciones. Resultados: No hubo diferencia en la efectividad de ambos tratamientos (100% en TAIA y 98,6% en hospitalizado; p: 0,41). La adherencia a TAIA fue 100%. La prevalencia de eventos adversos fue mayor en los hospitalizados (76,3 versus16,2%, p < 0,01). El costo directo promedio fue cuatro veces superior en hospitalizados, principalmente por costo día-cama. El costo indirecto fue similar. Hubo más días de ausentismo laboral y a centros de cuidado en hospitalizados (p: 0,017, p: 0,045, respectivamente). Conclusión: El tratamiento de ITU febril con TAIA en niños fue igualmente efectivo, más seguro y significativamente menos costoso que el hospitalizado y representa una intervención recomendable para los servicios pediátricos de hospitales públicos chilenos.