Economic Outcomes of Dalbavancin versus Standard Therapy in Staphylococcus aureus Bacteremia in the DOTS Randomized Clinical Trial.

Abstract

The DOTS trial demonstrated similar clinical outcomes among 200 adults with complicated Staphylococcus aureus bacteremia (SAB) randomized to two doses of dalbavancin or standard-therapy antibiotics after initial clearance. We aimed to determine whether the higher cost of dalbavancin is offset through reductions in medical resource use. We used dates for hospitalizations and antibiotics from the trial starting from randomization. Antibiotic costs were based on generic pricing for dalbavancin and most other antibiotics. Medicare payment rates were used to estimate costs for scenarios representing home-based or clinic-based outpatient antibiotic therapy (OPAT). On average, patients randomized to dalbavancin spent 2.2 fewer SAB-related days in the hospital (95%CI: -5.3 to 1.3) and received antibiotics on 24.4 fewer days (95%CI: -29.0 to -19.9). Mean inpatient costs for SAB-related admissions were lower by $5805 (95%CI: -14,311 to 3390) in the dalbavancin group. Antibiotic drug costs were $2343 higher (95%CI: 1728 to 3027), but OPAT costs were lower with dalbavancin by $2469 (95% CI: -2913 to -1970) in the home-based scenario and $1112 (95% CI: -1289 to -914) in the clinic-based scenario. Net costs for SAB-related care were $5931 lower (95%CI: -14,660 to 3004) and $4574 lower (95%CI: -13,312 to 4335) with dalbavancin versus standard-therapy with home-based and clinic-based OPAT, respectively. Among patients with injection drug use (IDU), savings with dalbavancin were approximately $22,000. On average, savings from reduced inpatient care and less OPAT fully offset the higher cost of dalbavancin in patients with SAB. Savings were greater in patients with IDU.