*I recently completed my postdoctoral training fellowship and no longer
have access to the email previously used (joella.adams@bmc.org
<joella.adams@bmc.org>). Please use this email or my new organizational
email (jadams@rti.org <jadams@rti.org>) for any correspondence. Thank you
for your understanding. *
*ABSTRACT*
*Background:* The incidence of drug-use associated infective endocarditis
(DUA-IE) is rising and posing significant costs on the healthcare system.
Alternative treatment strategies that shorten hospitalizations such as
outpatient parenteral antimicrobial therapy (OPAT) and partial oral
antibiotics (PO) may be as effective as the standard of care (prolonged
hospitalization for intravenous antibiotics [IVA]) while also decreasing
healthcare utilization costs. We evaluated long-term healthcare costs
associated with four antibiotic treatment strategies for DUA-IE.
*Methods*: We used a microsimulation model to perform a cost analysis of
the following DUA-IE treatment strategies: 1) 4-6 weeks of inpatient IVA
along with opioid detoxification, *status quo *(*SQ*); 2) 4-6 weeks of
inpatient IVA along with inpatient addiction care services (ACS) (*SQ with
ACS*); 3) 3 weeks of inpatient IVA with ACS followed by OPAT (*OPAT*); and
4) 3 weeks of IVA with ACS followed by PO antibiotics (*PO)*. We derived
costs from the Federal Supply Schedule, Physician Fee Schedule, and claims
data. Patients were eligible for OPAT either at home or in post-acute care.
We estimated life expectancy (LE) and total- and per-person inpatient and
outpatient costs ($US) from the payer perspective.
*Results*: The *SQ *scenario resulted in an average LE of 73.31y at a total
lifetime cost of $416,800/person, hospitalization costs = $14,000/person
and outpatient costs = $40,000/person. Both PO and OPAT substantially
decreased hospitalization costs compared to SQ: -$8,600/person (OPAT) and
-$5,500/person (PO) but did not significantly increase outpatient costs
(+$200-700/person). Compared to SQ, total lifetime costs were lower for
OPAT ($412,300/person) and PO ($414,000/person), but higher for SQ with ACS
($417,000/person). Compared to *SQ, *LE was extended in the other
strategies: 73.36 in *SQ with ACS*, 73.34 in *OPAT*, and 73.37 in *PO*.
*Conclusion*: Treating DUA-IE with OPAT or PO may decrease total lifetime
and hospitalization costs while simultaneously extending LE.
*Funding: *This work was supported by the National Institute on Drug Abuse
(JAB, AS: K01DA051684, JAB: DP2DA051864) and the National Institute of
Allergy and Infectious Diseases (JA, RJ:T32-AI052074, BPL: R01DA046527,
P30DA040500).
