Financial Analysis of Dalbavancin for Acute Bacterial Skin and Skin Structure Infections for Self-Pay Patients

© 2020, The Author(s). Introduction: Acute bacterial skin and skin structure infections (ABSSSI) are an increasing cause of admission in the self-pay population. We previously reported that patients with ABSSSI discharged to receive dalbavancin showed a decreased length of stay (LOS) and total direct costs without increasing 30-day readmission rate. For patients who are financially eligible, a dalbavancin vial replacement program can offset costs. The objective of this study was to determine cost differences in treating ABSSSI in self-pay inpatients discharged to receive dalbavancin compared to standard of care (SOC). Methods: This retrospective cohort within a community health system compared self-pay adult inpatients with ABSSSI from February 3, 2016 to August 5, 2019 discharged to receive dalbavancin at an outpatient infusion center with SOC intravenous antibiotics. Patients were included with cellulitis, abscess, or postoperative wound infections diagnoses on the basis of International Classification of Disease, Tenth Revision (ICD-10) codes. Excluded populations were patients without dalbavancin vial replacement performed, pregnant, infections caused exclusively by gram-negative bacteria or fungi, or ICD-10 codes not consistent with ABSSSI. The primary outcome was direct cost of hospital stay. Secondary outcomes included length of stay (LOS), 30-day readmission rates, adverse events (AE), and indirect hospital costs. On the basis of previous studies, a one-sided Student’s t test was performed on financial data. Results: Twelve dalbavancin and 263 SOC patients met inclusion criteria. Direct cost ($2758 vs$4010, p = 0.105) and indirect hospital cost ($2913 vs$3646 , p = 0.162) per patient were less in the dalbavancin group. There was no significant difference between median LOS (4 vs 4, p = 0.888), AE (0% vs 14.8%), and 30-day readmission rates for dalbavancin vs SOC group (8.3% vs 7.2%, p = 0.604). Conclusion: Self-pay patients with ABSSSI discharged to receive dalbavancin with vial replacement resulted in decreased direct and indirect costs per patient with similar 30-day readmission rates, AE, and LOS. More studies targeted toward this population are warranted to determine ultimate benefit

Baseline quality of life of caregivers of patients with heart failure prior to advanced therapies: Findings from the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) study

BACKGROUND: We compared HRQOL, depressive symptoms, anxiety and burden among caregivers of older HF patients based on intended patient therapy goal: awaiting heart transplantation (HT) with or without mechanical circulatory support (MCS); and prior to long-term MCS; and identified factors associated with HRQOL. METHODS: Caregivers (n=281) recruited from 13 U.S. HT and MCS programs, completed measures of HRQOL (EQ-5D-3L), depressive symptoms (PHQ-8), anxiety (STAI-state), and burden (Oberst Caregiving Burden Scale). Analyses included ANOVA, Kruskal-Wallis tests, chi-square tests, and linear regression. RESULTS: The majority of caregivers were female, white, spouses with ≤2 co-morbidities, median[Q1,Q3] age=62[57.8,67.0] years. Caregivers (HT with MCS=87, HT without MCS=98, long-term MCS=96) reported similarly high baseline HRQOL (EQ-5D-3L visual analog scale median score=90, p=0.67, for all groups) and low levels of depressive symptoms. STAI-state median scores were higher in the long-term MCS group versus the HT groups with and without MCS, (38 versus 32 versus 31, p\u3c0.001), respectively. Burden (task: time spent/difficulty) differed significantly among groups. Caregiver factors (number of comorbidities, diabetes, and higher anxiety levels) were significantly associated with worse caregiver HRQOL, R=26%. CONCLUSIONS: Recognizing caregiver-specific factors, including comorbidities and anxiety, associated with HRQOL of caregivers of these older advanced HF patients may guide support strategies

Caregiver burden before heart transplantation and long-term mechanical circulatory support: Findings from the Sustaining Quality of Life of the Aged: Transplant or Mechanical Support (SUSTAIN-IT) study

Background: Caregiving for heart failure (HF) patients is burdensome. We examined differences in caregiver burden for three groups of older advanced HF patients: (1) supported with mechanical circulatory support (MCS) before heart transplantation (HT MCS), (2) awaiting transplant without MCS (HT non-MCS), and (3) prior to long-term MCS and factors associated with burden. Methods: From 10/1/15-12/31/18, we enrolled 276 caregivers for HF patients from 13 U.S. sites: 85 HT MCS, 96 HT non-MCS, and 95 prior to long-term MCS. At enrollment, caregivers completed the Oberst Caregiving Burden Scale (15 items, 2 subscales: time (range=1-5; higher score=more time spent on task) and difficulty (range=1-5; higher score=higher difficulty of task) and other measures. Statistical analyses included descriptive statistics, ANOVA, chi-square tests, and linear regression. Results: Overall, caregivers were aged 60.8±9.8 years and predominantly white, female, spouses, well educated, and reported ≥1 comorbidities. Caregivers overall reported a moderate amount of time spent on tasks and slight task difficulty. Caregivers for HT non-MCS candidates reported significantly less perceived time spent on tasks than caregivers for HT MCS candidates and caregivers for patients prior to long-term MCS (2.2±0.74 vs 2.4±0.74 vs 2.5±0.71, respectively, p=0.02) and less perceived difficulty of tasks (1.2±0.33 vs 1.4±0.53 vs 1.4±0.54, respectively, p=0.01). Caregiver and patient factors were associated with caregiver burden. Conclusions: Prior to HT and long-term MCS, caregiver burden was low to moderate. Caregiver factors were predominantly associated with caregiver burden. Understanding caregiver burden and factors affecting caregiver burden may enhance preoperative advanced therapies discussions and guide caregiver support