JAC Advance Access originally published online on September 19, 2009
Journal of Antimicrobial Chemotherapy 2009 64(6):1316-1324; doi:10.1093/jac/dkp343
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Original research |
Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective
1 Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK 2 Health Economics and Decision Science (HEDS), and Trent Research and Development Support Unit, ScHARR, University of Sheffield, Sheffield S1 4DA, UK
Received 14 April 2009; returned 11 June 2009; revised 9 July 2009; accepted 28 August 2009
* Corresponding author. Tel: +44-114-2268874; Fax: +44-114-2268875; E-mail: ann.chapman{at}sth.nhs.uk
Objectives: Outpatient parenteral antibiotic therapy (OPAT) is an effective treatment strategy for a wide variety of infections as long as clinical risk is minimized by conforming to practice guidelines. However, its cost-effectiveness has not been established in the setting of the UK National Health Service. We examined the clinical efficacy and cost-effectiveness of an OPAT service based in a large UK teaching hospital, predominantly using the outpatient ‘infusion centre’ and patient/carer administration models of service delivery.
Patients and methods: Data on clinical activity and outcomes were collected prospectively on 334 episodes of treatment administered by the Sheffield OPAT service between January 2006 and January 2008. Cost-effectiveness was calculated by comparing real costs of OPAT with estimated inpatient costs for these patient episodes incorporating two additional sensitivity analyses.
Results: Of the OPAT episodes, 87% resulted in cure or improvement on completion of intravenous therapy. The readmission rate was 6.3%, and patient satisfaction was high. OPAT cost 41% of equivalent inpatient costs for an Infectious Diseases Unit, 47% of equivalent inpatient costs using national average costs and 61% of inpatient costs using minimum inpatient costs for each diagnosis.
Conclusions: Using this service model, OPAT is safe and clinically effective, with low rates of complications/readmissions and high levels of patient satisfaction. OPAT is cost-effective when compared with equivalent inpatient care in the UK healthcare setting.
Keywords: home infusion therapy , quality assurance , intravenous antibiotics , cost analysis