Abstract:
Background: Many patients with cellulitis are treated with oral antibiotics as outpatients, but some require hospital admission for intravenous antibiotics. During the coronavirus disease 2019 pandemic, Betsi Cadwaladr University Health Board (BCUHB) in Wales approved use of dalbavancin as first-line intravenous antibiotic from April to December 2020 to facilitate early discharge and prevent hospital admission.
Objectives: To report cost savings and admission avoidance through first-line intravenous use of dalbavancin for cellulitis in one health board in Wales.
Patients and methods: Patients with cellulitis who presented to the emergency department (ED) or medical assessment unit (MAU) at BCUHB’s two hospitals between April and December 2020 were identified for treatment with dalbavancin, because they had not responded to oral antibiotics or their initial presentation warranted intravenous antibiotics. Patients received 1500mg dalbavancin by intravenous infusion according to prescribing information and were sent home without being admitted. Outcomes were admission within 30 days of dalbavancin and cost savings from avoiding admission.
Results: 31 patients were treated with dalbavancin for cellulitis in the ED or MAU. No patient was admitted within 30 days of receiving dalbavancin. Use of dalbavancin is estimated to have saved 248 bed-days over the study period, with an estimated saving of $120,444.23 based on avoidance of admission. The cost of dalbavancin for these 31 patients was $69,959.08, giving an overall cost saving of $50,485.15 ($1,529.95 per patient)
Conclusions: Prescribing dalbavancin as first-line intravenous antibiotic for cellulitis prevents admission, saving bed-days and admission-related costs.
Reference:Ben-Sassi K, Sarwar S. Impact of first-line dalbavancin for cellulitis on hospital admissions and costs: a case series. J Glob Antimicrob Resist. 2024 May 29:S2213-7165(24)00108-5. doi: 10.1016/j.jgar.2024.05.020. Epub ahead of print. PMID: 38821442.