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Background: A pathway for the treatment of acute bacterial skin and skin structure infections (ABSSSI) with a single intravenous (IV) dose of dalbavancin was previously shown to reduce hospital admissions and shorten inpatient length of stay (LOS). Objectives: To describe pathway implementation at the emergency department (ED) and evaluate cost-effectiveness of a single-dose dalbavancin administered to ED patients who would otherwise be hospitalized to receive usual care with multidose IV antibiotics. Methods: The dalbavancin pathway was previously implemented at 11 US EDs (doi: 10. 1111/acem. 14258). Patients with ABSSSI, without an unstable comorbidity or infection complication requiring complex management, were treated with a single dose of dalbavancin. At the ED physicians' discretion, patients were either discharged and received outpatient follow-up or were hospitalized for continued management. A decision analytic cost-effectiveness model was developed from the US healthcare's perspective to evaluate costs associated with the dalbavancin pathway compared with inpatient usual care. Costs (2021 USD) were modeled over a 14-day horizon and included ED visits, drug costs, inpatient stay, and physician visits. One-way and probabilistic sensitivity analyses examined input parameter uncertainty. Results: Driven largely by the per diem inpatient cost and LOS for usual care, the dalbavancin pathway was associated with savings of 5133. 20 per patient and 1211. 57 per hospitalization day avoided, compared with inpatient usual care. The results remained robust in sensitivity and scenario analyses. Conclusion: The new single-dose dalbavancin ED pathway for ABSSSI treatment, which was previously implemented at 11 US EDs, offers robust cost savings compared to inpatient usual care.
LoVecchio et al. (Tue,) studied this question.