Cost analysis of disease including treatment with dalbavancin in a Spanish hospital: ECODAL ANALYSIS

Figures & data

Table 1. Diagnostic tests and intervention costs.

Item	Unit cost (€)
Hemogram	10
Clotting time	0.9
Biochemistry: lipid profile (TG, CT, HDL, LDL)	10
Biochemistry: liver function tests (GOT, GPT, BT, GGT, LDH, FA)	6
Basic Biochemistry: (glucose, urea, creatinine, K, Na)	6
Biochemistry: renal profile (urea, creatinine, MDRD, uric acid)	13
C-reactive protein	3.89
Proteinogram	0.87
Erythrocyte sedimentation rate	0.87
Creatine Kinase	0.87
Lymphocite populations or subpopulations	64.88
Immunological tests	21
Procalcitonin	6
Arterial blood gas test	13
Clinical urine test	6
Blood culture	21
Urine culture	16
Stool culture	63
Urine toxicology test	38.93
S. pneumoniae/Legionella Antigenuria	7
Quantiferon-TB	30
Troponin T	43.25
Quantitative RNA PCR for HIV (viral load)	60
Iron profile tests	14.44
Atypical bacteria serology (Coxiella, Chlamydia, Mycoplasma)	6
16s universal PCR for bacteria in biopsy	71.42
Bacterial and fungal culture (any sample)	21
Cardiac valve 16s universal PCR	71.42
Transthoracic echocardiogram	215
Transesophageal echocardiogram	35.69
Abdominal echography	39.88
Panendoscopy	38.41
Computed tomography (with contrast)	190
Computed tomography (without contrast)	86
Any type of X-ray	12.75
Other non-abdominal echography	38.41
Magnetic resonance imaging	130
Magnetic resonance imaging (with contrast)	180
Positron emission tomography	1,290
Heart valve surgery	35,702
Trauma surgery*	5,000
Pacemaker/implantable cardioverter-defibrillator implantation or replacement	10,250
Peripherally inserted central catheter	58.95
Hickman catheter	55.58
Hospital stay, infectious diseases ward (day)	296.85
Hospital stay, general ward (day)	250
Hospital stay, ICU (day)	1,100
Home hospitalization (day)	200
Re-admission (day)	250
Day-care hospital (day)	277
Referral (h)	70
Nurse	69
Ambulatory visit (h)	115

*Mean price: knee, hip, and tibial surgery.

Table 2. Patient's baseline characteristics and main infections.

Baseline characteristics
Sex	29.4% Women	70.6% Men
Age	57.9 mean (±16.3)	55 median (IQR, 48.2–65.7)
Underlying diseases	N (%)
Cardiovascular disease	11 (32.3)
Diabetes mellitus	9 (26.5)
Liver disease	7 (20.6)
Child A	3 (42.9)
Child B	4 (57.1)
Meld score	Mean 12.4 (±8.8)
Child-Pugh (5–7)	4 (57.1)
Child-Pugh (7–9)	3 (42.9)
Respiratory disease	6 (17.6)
Neurologic disease	5 (14.7)
Immunosuppressive treatment/corticoids (on the previous month)	5 (14.7)
Active solid neoplasia	4 (11.8)
Chronic renal disease	3 (8.8)
Gastrointestinal tract disease	3 (8.8)
HIV infection	2 (5.9)
Haemodialysis	1 (2.9)
Solid organ transplant	1 (2.9)
Peritoneal dialysis	–
Hematopoietic stem cell transplantation	–
McCabe scale	Ultimately fatal, 5 (14.7)
Charlson comorbidity index	Mean 1.97 (±1.8)
No comorbidity (0–1)	15 (±44.1)
Low comorbidity (2)	8 (±23.5)
High comorbidity (+3)	11 (±32.3)
Main infection and aetiology
Osteoarticular infection (n = 11)*	CoNS, n = 3 MSSA, n = 2 CoNS + Enterococcus faecalis, n = 1 CoNs + Corynebacterium striatum, n = 1 CoNS + Cutibacterium acnes, n = 1 Enterococcus faecium, n = 1 Enterococcus faecalis + Corynebacterium striatum, n = 1 Enterococcus faecalis, n = 1
Endocarditis (n = 10)	MSSA, n = 4 Streptococcus spp., n = 2 CoNS, n = 2 MRSA, n = 1 Unknown, n = 1
Catheter related bacteraemia (n = 3)	MSSA, n = 1 MRSA, n = 1 CoNS + Enterococcus faecalis, n = 1
Thrombophlebitis (n = 3)	MSSA, n = 2 MRSA, n = 1
ABSSSI (n = 2)	CoNS, n = 1 MSSA, n = 1
Pacemaker/Intracardiac device infection (n = 2)	CoNS, n = 1 MSSA, n = 1
Bacteremia overall (n = 2)	MSSA, n = 2
Necrotising pneumonia and empyema (n = 1)	MRSA, n = 1

Abbreviations. ABSSSI: acute bacterial skin and skin structure infection; CoNS: coagulase-negative Staphylococci; HIV: human immunodeficiency virus; MRSA: methicillin resistant Staphylococcus aureus; MSSA: methicillin susceptible Staphylococcus aureus.

*Osteoarticular infection: comprising prosthetic joint infection (n = 5, 14.7%), osteomyelitis (n = 3, 8.8%), septic arthritis (n=2, 5.9%), and spondylodiscitis (n = 1, 2.9%)

Table 3. Mean costs per patient and total budget impact (base case).

		Mean cost (€)	Budget impact* (€)
Diagnostic tests		1,201	40,834
Interventions		8,413	286,042
Stay	Hospital stays	6,885	234,090
	ICU stay	809	27,506
	Day care hospital stay	195	6,630
	Home hospitalization	94	3,196
	Re-admission	79	2,686
	Total	8,062	274,108
Pharmacological costs	Previous antibiotic treatment	880	29,939
	Dalbavancin	3,936	133,841
	Concomitant treatment	90	3,063
	Total	4,907	166,843
Consultations	Referred patients	13	442
	Nursing	25	850
	Outpatient visit	32	1,088
	Total	70	2,380
	Previous antibiotic administration	45	1,530
	Dalbavancin administration	41	1,394
	Adverse events	0	0
	Total	86	2,924
	Direct Costs	22,738	773,087

Abbreviation. ICU: intensive care unit.

*n: total cohort

Table 4. Costs per microorganism causing infection, type of infection, and patient's baseline characteristics.

Baseline characteristics		n	Mean	Lower CI95%**	Upper CI95%	SD (±)	Median	Min	Max	p-Value
Sex	Female	10	21,291	9,272	33,309	16,801	21,730	3,390	45,462	.75
	Male	24	23,341	14,281	32,401	21,457	14,260	2,859	95,142
Age	18–45	7	17,498	13	34,983	18,906	8,436	3,390	57,627	.23
	46–55	11	19,071	9,484	28,659	14,271	15,465	3,402	45,216
	56–65	7	27,170	0	57,496	32,790	10,604	2,859	95,142
	66–75	3	38,794	17,155	60,433	8,711	41,982	28,938	45,462
	76–85	2	37,473	0	163,896	14,071	37,473	27,523	47,423
	>86	4	14,825	562	29,088	8,963	12,089	7,369	27,754
Cardiovascular disease		11	29,662	10,270	49,053	28,864	15,143	4,192	95,142	.59
Chronic kidney disease		3	21,038	0	66,571	18,329	13,376	7,783	41,955	.95
Haemodyalisis		1	41,955	–	–	NA	41,955	41,955	41,955	NE
Respiratory disease		6	8,164	5,039	11,289	2,978	7,903	4,192	12,337	.01*
Diabetes Mellitus		9	22,525	9,860	35,191	16,478	23,318	2,859	47,423	.91
Neurologic disease		5	9,561	6,445	12,677	2,510	8,436	7,369	13,376	.10
Liver disease		7	18,624	2,531	34,718	17,401	12,337	7,783	57,627	.80
Gastrointestinal disease		3	26,978	458	53,499	10,676	27,754	15,936	37,246	.32
Active solid neoplasia		4	28,762	0	57,727	18,203	33,092	3,402	45,462	.42
HIV infection		2	13,740	0	31,569	1,984	13,740	12,337	15,143	.86
Type of infection		n	Mean	Lower CI95%**	Upper CI95%	SD (±)	Median	Min	Max	p-Value
Osteoarticular infection		11	24,242	14,825	33,660	14,018	23,318	7,783	45,216	.31
Endocarditis		10	33,433	13,384	53,481	28,026	21,610	7,369	95,142	.08
Catheter-related bacteraemia		3	7,844	0	25,281	7,019	4,192	3,402	15,936	.12
Infectious thrombophlebitis		3	21,210	0	65,863	17,975	11,411	10,263	41,955	1.00
ABSSSI		2	5,605	0	33,761	3,134	5,605	3,390	7,821	.07
CIED infection		2	17,492	0	162,930	16,187	17,492	6,046	28,938	.75
Bacteraemia		2	15,191	0	171,888	17,441	15,191	2,859	27,523	.47
Microorganism causing infection		n	Mean	Lower CI95%**	Upper CI95%	SD (±)	Median	Min	Max	p-Value
MSSA		13	26,706	10,675	42,737	26,528	15,465	2,859	95,142	.86
CoNS		7	29,481	11,098	47,865	19,877	41,982	3,390	47,423	.34
MRSA		4	10,768	4,641	16,896	3,851	9,884	7,369	15,936	.26
CoNS + Enterococcus faecalis		2	13,755	0	135,260	13,524	13,755	4,192	23,318	.80
Streptococcus spp.		2	20,045	0	117,992	10,902	20,045	12,337	27,754	.80
CoNS + Corynebacterium striatum		1	13,376	–	–	NA	13,376	13,376	13,376	NE
CoNS + Cutibacterium acnes		1	24,518	–	–	NA	24,518	24,518	24,518	NE
Enterococcus faecalis		1	10,801	–	–	NA	10,801	10,801	10,801	NE
Enterococcus faecium		1	37,246	–	–	NA	37,246	37,246	37,246	NE
Enterococcus faecalis + Corynebacterium striatum		1	7,783	–	–	NA	7,783	7,783	7,783	NE
Empirical treatment		1	15,143	–	–	NA	15,143	15,143	15,143	NE

Abbreviations. CIED: cardioelectronic implantable electric device (pacemaker/cardioverter-defibrillator); CoNS: coagulase-negative Staphylococci; CI: confidence interval; MRSA: methicillin resistant Staphylococcus aureus; MSSA: methicillin susceptible Staphylococcus aureus; NE: Not evaluable.

*p values <0.05; **Negative values were switch to zero.

Table 5. Characteristics of the hypothetical alternative treatment.

Pharmacological treatment
First alternative antibiotic	% Patients	Mean days on treatment	Standard deviation (±)	Mean daily dose (mg)	Standard deviation (±)
Daptomycin	38	30.38	33.9	765	153.3
Linezolid	24	54.13	87.6	1,200	–
Tedizolid	12	91.00	54.2	200	–
Vancomycin	5.9	21.00	9.9	714	404.1
Cefazolin	5.9	21.00	9.9	6,000	–
Ceftriaxone	5.9	14.50	0.7	3,000	1,414.2
Levofloxacin	2.9	168.00	–	500
Trimethoprim- sulfamethoxazole	2.9	14.00	–	160/800	–
Daptomycin + Levofloxacin	2.9	14.00	–	750	–
Second alternative antibiotic
Trimethoprim- sulfamethoxazole	40	15	–	160/800	–
Ampicillin	20	84	–	12000	–
Tedizolid	20	40	–	200	–
Levofloxacin	20	14	–	500	–
Resource use
Days	Patients	Mean	Standard deviation
Hospital stays	15	16.80	6.3
Home hospitalization	44	32.93	45.2
Day care hospital	38	2.85	2.3
Units	Patients	Mean	Standard deviation
CVC	38	24.85	27.2
PICC	18	9.67	6.7
Peripheral catheter	3	14.00	–

Abbreviations. CVC: central venous catheter; PICC: peripherally inserted central catheter.

Table 6. Mean cost per patient for base case scenario, hypothetical therapeutic alternative scenario, treatment with daptomycin scenario and scenario without treatment assuming hospital stay.

		Base case (€)	Hypothetical therapeutic alternative scenario (€)	Hypothetical treatment with daptomycin scenario (€)	Hypothetical scenario without treatment, assuming hospital stay (€)
Diagnostic tests		1,201	1,201	1,201	1,201
Interventions		8,413	8,413	8,413	8,413
Stay	Hospital stays	6,885	7,503	6,885	20,959
	ICU stays	809	809	809	809
	Day-care hospital stays	195	301	12,229	195
	Home hospitalization	94	2,906	–	94
	Re-admission^#	79	–	79	79
	Total	8,062	11,519	20,002	22,136
Pharmacological costs	Previous antibiotic treatment	880	880	880	880
	Antibiotic treatment: Dalbavancin	3,936	–	–	–
	Antibiotic treatment: others	–	3,772	2,995	–
	Concomitant treatment	90	180	90	90
	Total	4,907	4,832	3,965	970
Consultations	Referred patients	13	13	13	13
	Nursing	25	25	25	25
	Outpatient visit	32	32	32	32
	Total	70	70	70	70
Other costs	Previous antibiotic administration	45	45	45	45
	Drug administration	41	52	82	0
	Adverse events	0	0	0	0
	Total	86	97	127	45
	Direct costs	22,738	26,062	33,776	32,835
Mean difference between scenario and base case		–	3,324	11,038	10,097

Abbreviation. ICU: intensive care unit; ^#re-admission not associated with dalbavancin.