Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system

ABSTRACT

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.

KEYWORDS:

• Economic evaluation
• cost-utility analysis
• anti-infective agents
• outpatient parenteral antimicrobial therapy
• OPAT
• Brazil

Acknowledgments

The authors are grateful to the staff at the day hospital and the Hospital Epidemiology Department who helped care for the OPAT patients at our hospital and consented to this study. We would also like to thank the team at the HC Unicamp Health Technology Assessment Department and the library at the Unicamp School of Medical Sciences for the methodological support.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceived and designed the experiments: EMP ENS MRR. Contributed to the collection of epidemiological and clinical data: EMP, MRR, MLM, PT, RSBS, FHA, LGOC, CCH, LFB, DFP, MRCC, CST, RFR, SMQC. Collected the economic data: EMP. Analyzed the data and drafted the manuscript: EMP ENS MRR. Revised it critically for intellectual content: MLM PT. Provided editorial advice: EMP ENS MRR.

Ethical approval

The study was submitted to the Research Ethics Committee of the Unicamp School of Medical Sciences and approved without restrictions (protocol no. 886.778).

Supplementary material

Supplemental data can be accessed here.

Additional information

Funding

The project is funded by public resources from the Research Support Foundation for São Paulo State (FAPESP), which covers the costs of the materials and antimicrobials used to care for the OPAT patients [Research Financial Support 2014/50045-3].