1556 - Financial Analysis of Dalbavancin for Acute Bacterial Skin and Skin Structure Infections in a self-pay population

Background: Acute bacterial skin and skin structure infections (ABSSSI) are an increasing cause of admission in the self-pay population and can be difficult to treat due to socioeconomic status. We have previously described ABSSSI patients discharged to receive dalbavancin, a novel lipoglycopeptide, and shown a decreased length of stay (LOS) and total direct costs without increasing 30-day readmission rate. For patients who are financially eligible, a dalbavancin vial replacement program can offset costs in this population. The objective of this study was to determine cost differences in treating ABSSSI in self-pay inpatients discharged to receive dalbavancin compared to standard of care (SOC).

Methods: This retrospective cohort within a community health system compared self-pay adult inpatients with ABSSSI from 2/3/16 - 8/5/19 discharged to receive dalbavancin at an outpatient infusion center with SOC intravenous antibiotics. Patients were included with a diagnosis of cellulitis, abscess, or postoperative wound infections based on International Classification of Disease 10 (ICD-10) codes. Excluded populations were those without dalbavancin vial replacement performed, pregnant patients, infections caused exclusively by gram-negative bacteria or fungi, or ICD-10 codes not consistent with ABSSSI. The primary outcome was direct cost of hospital stay. Secondary outcomes included LOS, 30-day readmission rates, adverse events (AE), and indirect hospital costs. Based on previous studies, a one-sided Student’s t-test with an alpha of 0.025 deeming statistical significance was performed on the financial data.

Results: Twelve dalbavancin and 263 SOC patients met criteria for study entry. Direct cost ($2,758 vs $4,010, p=0.105) and indirect hospital cost ($2,913 vs $3,645, p=0.162) per patient was less in the dalbavancin group. There was no significant difference between median LOS (4 vs 4, p=0.888), AE (0% vs 14.8%), and 30-day readmission rates for dalbavancin vs SOC group (8.3% vs 7.2%, p=0.604).

Conclusion: Self-pay ABSSSI patients discharged to receive dalbavancin with vial replacement resulted in decreased direct and indirect cost per patient with similar 30-day readmission rates, AE, and LOS. More studies targeted toward this population are warranted to determine ultimate benefit.