Dehospitalization: pharmacoeconomic aspects and the impacts of days saved from hospitalization in renal transplant patients using carbapenems

Authors

  • Thaynara Carvalho DE FREITAS
  • João Antonio DE SOUSA
  • Alene Barros DE OLIVEIRA
  • Maria Gabrielle LINHARES
  • Cinthya Cavalcante DE ANDRADE
  • Evelyne Santana GIRÃO
  • Henry Pablo REIS

DOI:

https://doi.org/10.30968/rbfhss.2023.143.0994

Abstract

Purpose: To carry out an analysis cost minimization and patient outcomes submitted to OPAT of carbapenems in a teaching hospital in the state of Ceará. Methodology: This is a descriptive and retrospective observational study with a quantitative, characterized as a pharmacoeconomic analysis of cost minimization of the treatment performed with meropenem in patients hospitalized in the renal transplant units of a teaching hospital in the state of Ceará and outpatients who migrated for OPAT with ertapenem in outpatient services. The clinical outcome was evaluated by measuring the readmission rate up to 30 days after the end of treatment. Results: Eight patients were selected for the study. The microbiological profile verified the predominance of infections caused by Enterobacteriaceae (Klebsiella pneumoniae and Escherichia coli), representing 75% of the microbiological isolates. The cost analysis found a daily cost of U$ 60.04 in the treatment conducted with meropenem in hospitalized patients, in contrast, the daily cost in OPAT performed with ertapenem was US$ 78.79. The treatments performed totaled a cost of U$ 7,515.89 for the institution, and in an unprecedented way we evidenced a cost reduced from US$ 1029.45 if the treatment were fully carried out during the hospitalization (US$ 6,484.44). Conclusion: There was an incremental cost during dehospitalization in relation to the treatment performed during hospitalization hospital, on the other hand, a higher bed turnover can be observed, which makes it possible to perform more transplants.

Downloads

Download data is not yet available.

References

Mahoney MV, Childs-Kean LM, Khan P, et al. Recent Updates in Antimicrobial Stewardship in Outpatient Parenteral Antimicrobial Therapy. Curr Infect Dis Rep. 2021;23(12):24. DOI: 10.1007/s11908-021-00766-x.

Hamad Y, Lane MA, Beekmann SE, Polgreen PM, Keller SC. Perspectives of United States-based Infectious Diseases Physicians on Outpatient Parenteral Antimicrobial Therapy Practice. Open Forum Infect Dis. 2019;6(10):ofz363. DOI: 10.1093/ofid/ofz363.

Durojaiye OC, Cartwright K, Ntziora F. Outpatient parenteral antimicrobial therapy (OPAT) in the UK: a cross-sectional survey of acute hospital trusts and health boards. Diagn Microbiol Infect Dis. 2019;93(1):58-62. DOI: 10.1016/j.diagmicrobio.2018.07.013.

Sociedade Brasileira de Infectologia. Diretrizes Brasileiras para Terapia Antimicrobiana parenteral ambulatorial. 2020. 5. Zhanel GG, Wiebe R, Dilay L, et al. Comparative review of the carbapenems. Drugs. 2007; 67(7):1027-52. DOI: 10.2165/00003495-200767070-00006.

Bazaz R, Chapman AL, Winstanley TG. Ertapenem administered as outpatient parenteral antibiotic therapy for urinary tract infections caused by extendedspectrum-β-lactamase-producing Gram-negative organisms. Antimicrob Chemother. 2010; 65(7):1510-3. DOI: 10.1093/jac/dkq152.

Tice AD. Ertapenem: a new opportunity for outpatient parenteral antimicrobial therapy. J Antimicrob Chemother. 2004;53 (2):83-86. DOI: 10.1093/jac/dkh210.

Ramasubramanian V, Murlidharan P, Nambi S, et al. Efficacy and Cost Comparison of Ertapenem as Outpatient Parenteral Antimicrobial Therapy in Acute Pyelonephritis due to Extended-spectrum Beta-lactamase-producing Enterobacteriaceae. Indian J Nephrol. 2018;28(5): 351–357. DOI: 10.4103/ijn.IJN_207_17.

Dimitrova M, Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses. BMJ Open. 2021;11(9):e049733. DOI: 10.1136/bmjopen-2021-049733.

Taminato M, Fram D, Pereira RRF, et al. Infection related to Klebsiella pneumoniae producing carbapenemase in renal transplant patients. Rev Bras 341 Enferm. 2019; 72(3):760-6. DOI: http://dx.doi.org/10.1590/0034-7167-2019-0009.

Brakemeier S, Taxeidi SI, Zukunft B, et l. Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae –Related Urinary Tract Infection in Kidney Transplant Recipients: risk factors, treatment, and long-term outcome. Transplant 346 Proc. 2017;49(8):1757-1765. DOI: http://dx.doi.org/10.1016/j.transproceed.2017.06.033.

Espinar MJ, Miranda IM, Costa-de-Oliveira S, et al. Urinary Tract Infections in Kidney Transplant Patients Due to Escherichia coli and Klebsiella pneumonia Producing Extended-Spectrum β-Lactamases: Risk Factors and Molecular Epidemiology. PLoS ONE. 10(8): e0134737. DOI:10.1371/journal.pone.0134737.

Zhang Y, Wang Y, Van Driel ML, et al. Network meta-analysis andpharmacoeconomic evaluation of antibiotics for the treatment of patients infected with complicated skin and soft structure infection and hospital-acquired or ventilator-associated penumonia. Antimicrob Resist Infect Control. 2019; (8), 72. DOI: https://doi.org/10.1186/s13756-019-0518-2.

Peña A, Zambrano A, Alvarado M, et al. Evaluación de la efectividad, seguridad y costos del tratamiento antimicrobiano intravenoso ambulatorio (TAIA) vs hospitalizado en infección urinaria en pediatria. Rev Chil Infectol. 2013;30 (4): 426-434.

Izaias EM, Dellaroza MSG, Rossaneis MA, Belei RA. Custo e caracterização de infecção hospitalar em idosos. Ciênc Saúde Colet. 2014;9(8):3395-3402. DOI: org/10.1590/1413-81232014198.12732013.

Psaltikidis EM, Silva END, Moretti ML, et al. Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system. Expert Rev Pharmacoecon Outcomes Res. 2019;19(3):341-352. DOI: 10.1080/14737167.2019.1541404.

Published

2023-09-27

How to Cite

1.
DE FREITAS TC, DE SOUSA JA, DE OLIVEIRA AB, LINHARES MG, DE ANDRADE CC, GIRÃO ES, REIS HP. Dehospitalization: pharmacoeconomic aspects and the impacts of days saved from hospitalization in renal transplant patients using carbapenems. Rev Bras Farm Hosp Serv Saude [Internet]. 2023Sep.27 [cited 2024Dec.7];14(3):994. Available from: https://rbfhss.org.br/sbrafh/article/view/994

Issue

Section

ORIGINAL ARTICLES

Most read articles by the same author(s)