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      Potential savings through single-dose intravenous Dalbavancin in long-term MRSA infection treatment – a health economic analysis using German DRG data

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          Abstract

          Complicated infections such as osteomyelitis, skin and soft tissue infections or endocarditis often require antibiotic therapies that can last up to several weeks. The prolonged hospital length of stay (LOS) leads to a dramatic increase in costs. Single-dose intravenous Dalbavancin is a novel antimicrobial agent for the treatment of acute bacterial skin, skin structure and soft tissue infections (ABSSSI) that allows an earlier discharge of patients, resulting in potential savings. Joint, bone and prostheses infections (JBPI) are also related with long LOS. The aim of this study is to determine the economic effects of single-dose intravenous Dalbavancin in suitable patients with Methicillin-resistant Staphylococcus aureus infections in Germany. For this purpose, an analysis with real-world patient treatment data was performed, which was subsequently validated in a large German hospital. In total, ABSSSI patients with MRSA infections could stay 6.45 days shorter and 2,865 € could be saved while JBPI patients could be discharged eventually 10.6 days earlier and 3,909 € could be saved. Single-dose intravenous Dalbavancin is thus an option for patients with ABSSSI and JBPI who are eligible for discharge.

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          Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe.

          B Cookson, S Harbarth, Henriëtte E. van der Horst … (2010)
          Methicillin-resistant Staphylococcus aureus (MRSA) isa major cause of healthcare- and community-associated infections worldwide. Within the healthcare setting alone, MRSA infections are estimated to affect more than 150,000 patients annually in the European Union (EU), resulting in attributable extra in-hospital costs of EUR 380 million for EU healthcare systems. Pan-European surveillance data on bloodstream infections show marked variability among EU Member States in the proportion of S. aureus that are methicillin-resistant, ranging from less than 1% to more than 50%. In the past five years, the MRSA bacteraemia rates have decreased significantly in 10 EU countries with higher endemic rates of MRSA infections. In addition to healthcare-associated infections, new MRSA strains have recently emerged as community and livestock-associated human pathogens in most EU Member States. The prevention and control of MRSA have therefore been identified as public health priorities in the EU. In this review, we describe the current burden of MRSA infections in healthcare and community settings across Europe and outline the main threats caused by recent changes in the epidemiology of MRSA. Thereby, we aim at identifying unmet needs of surveillance, prevention and control of MRSA in Europe.
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            Extended-duration dosing and distribution of dalbavancin into bone and articular tissue.

            Michael Dunne, Sailaja Puttagunta, Craig Sprenger … (2015)
            Dalbavancin is an intravenous lipoglycopeptide with activity against Gram-positive pathogens and an MIC90 for Staphylococcus aureus of 0.06 μg/ml. With a terminal half-life of >14 days, dosing regimens with infrequent parenteral administration become available to treat infectious diseases such as osteomyelitis and endocarditis that otherwise require daily dosing for many weeks. In order to support a rationale for these novel regimens, the pharmacokinetics over an extended dosing interval and the distribution of dalbavancin into bone and articular tissue were studied in two phase I trials and pharmacokinetic modeling was performed. Intravenous administration of 1,000 mg of dalbavancin on day 1 followed by 500 mg weekly for seven additional weeks was well tolerated and did not demonstrate evidence of drug accumulation. In a separate study, dalbavancin concentrations in cortical bone 12 h after infusion of a single 1,000-mg intravenous infusion were 6.3 μg/g and 2 weeks later were 4.1 μg/g. A two-dose, once-weekly regimen that would provide tissue exposure over the dalbavancin MIC for Staphylococcus aureus for 8 weeks, maximizing the initial exposure to treatment while minimizing the frequency of intravenous therapy, is proposed.
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              Management of spinal infection: a review of the literature

              Sara Lener, Sebastian Hartmann, Giuseppe Barbagallo … (2018)
              Spinal infection (SI) is defined as an infectious disease affecting the vertebral body, the intervertebral disc, and/or adjacent paraspinal tissue and represents 2–7% of all musculoskeletal infections. There are numerous factors, which may facilitate the development of SI including not only advanced patient age and comorbidities but also spinal surgery. Due to the low specificity of signs, the delay in diagnosis of SI remains an important issue and poor outcome is frequently seen. Diagnosis should always be supported by clinical, laboratory, and imaging findings, magnetic resonance imaging (MRI) remaining the most reliable method. Management of SI depends on the location of the infection (i.e., intraspinal, intervertebral, paraspinal), on the disease progression, and of course on the patient’s general condition, considering age and comorbidities. Conservative treatment mostly is reasonable in early stages with no or minor neurologic deficits and in case of severe comorbidities, which limit surgical options. Nevertheless, solely medical treatment often fails. Therefore, in case of doubt, surgical treatment should be considered. The final result in conservative as well as in surgical treatment always is bony fusion. Furthermore, both options require a concomitant antimicrobial therapy, initially applied intravenously and administered orally thereafter. The optimal duration of antibiotic therapy remains controversial, but should never undercut 6 weeks. Due to a heterogeneous and often comorbid patient population and the wide variety of treatment options, no generally applicable guidelines for SI exist and management remains a challenge. Thus, future prospective randomized trials are necessary to substantiate treatment strategies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): GMS Infect Dis
                Journal ID (iso-abbrev): GMS Infect Dis
                Journal ID (publisher-id): GMS Infect Dis
                Title: GMS Infectious Diseases
                Publisher: German Medical Science GMS Publishing House
                ISSN (Electronic): 2195-8831
                Publication date (Electronic): 23 October 2019
                Publication date Collection: 2019
                Volume: 7
                Electronic Location Identifier: Doc03
                Affiliations
                [1 ]inspiring-health GmbH, Munich, Germany
                [2 ]Klinikum Barnim GmbH, Werner Forßmann Krankenhaus, Eberswalde, Germany
                Author notes
                *To whom correspondence should be addressed: Klaus-Friedrich Bodmann, Klinikum Barnim GmbH, Werner Forßmann Krankenhaus, Eberswalde, Germany, E-mail: kf.Bodmann@ 123456klinikum-barnim.de
                Article
                Publisher ID: id000043 Publisher ID: Doc03 Other ID: urn:nbn:de:0183-id0000434
                DOI: 10.3205/id000043
                PMC ID: 6839362
                PubMed ID: 31728264
                SO-VID: e80ae98b-88ad-4d9d-8c68-725ea097476a
                Copyright © Copyright © 2019 Wilke et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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                Subject: Article

                Keywords: single-dose intravenous dalbavancin,health economic model,length of stay,cost savings
                Data availability:
                Keywords: single-dose intravenous dalbavancin, health economic model, length of stay, cost savings

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