Economic evaluation of outpatient parenteral antimicrobial therapy: a systematic review

ABSTRACT

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.

KEYWORDS:

• Anti-infection agents
• economic evaluation
• outpatient parenteral antimicrobial therapy
• OPAT
• infectious diseases

Acknowledgments

We thank Ms. Rosana Evangelista-Poderoso – Lib., MSc., Library director at the Library of Faculty of Medical Sciences of the University of Campinas for the preparation and application of research strategies using electronic databases.

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. Partial results were presented at International Society for Pharmacoeconomics and Outcomes Research 18th Annual European Congress. Milan, Italy, Abstract: Value Health. 2015 Nov;18(7):A582-3. doi:10.1016/j.jval.2015.09.1950. Epub 20 October 2015

supplemental data

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Additional information

Funding

The article is funded by São Paulo Research Foundation (FAPESP) Research Financial Support, 2014/50,045-3.