The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.

Treating drug use-associated infective endocarditis (DUA-IE) with outpatient parenteral antimicrobial therapy (OPAT) and partial oral antibiotics (PO) may improve clinical outcomes and be cost-effective treatment options, according to research presented at IDWeek, held virtually from September 29 to October 3, 2021.

The standard treatment for DUA-IE comprises 4 to 6 weeks of inpatient intravenous antibiotics (IVA). However, clinical outcomes balanced with cost-effectiveness may indicate that shortened inpatient treatment with OPAT or PO may be more effective strategies. Researchers from Boston Medical Center evaluated the cost-effectiveness and clinical outcomes of 4 treatment strategies for patients with DUA-IE.


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The treatment strategies comprised 4 to 6 weeks of inpatient IVA with opioid detoxification; 4 to 6 weeks of inpatient IVA with addiction care services (ACS); 3 weeks of inpatient IVA, ACS, or OPAT; or 3 weeks of inpatient IVA, ACS, or PO.

At a cost of $416,800 per person and an average life expectancy of 73.314 discounted life-years, the typical therapy of 4- to 6-week IVA therapy with opioid detoxification resulted in a cure rate of 77.74% and a mortality rate of 5.02%.

The researched noted that cure rates were increased for the PO strategy (80.20%), followed by OPAT (78.45%) and IVA with ACS (77.86%). In addition, an association between the alternative treatment strategies and decreased mortality rates were also noted, with the greatest decreases observed among patients treated with PO (4.78%), followed by those treated with IVA with ACS (4.85%), and then those treated with OPAT (4.90%).

The average life expectancy was increased by a fraction of a year for all of the alternative treatment strategies: OPAT (73.344 life-years), PO (73.374 life-years), IVA with ACS (73.358 life-years).

For cost-effectiveness, the most cost-effective treatment was OPAT ($412,300 per person), and the incremental cost-effectiveness ratio of the PO strategy was $141,500 per life-year.

The researchers concluded that the OPAT or PO strategies combined with 3 weeks of inpatient treatment with IVA and ACS were associated with improved clinical outcomes compared with the standard treatment of 4 to 6 weeks of IVA with opioid detoxification. In addition, both the OPAT and PO strategies were associated with increased cost-effectiveness compared with the inpatient treatment strategies.

Disclosure: One author declared affiliations with industry. Please see the original reference for a full list of disclosures.

Reference

Adams JW, Savinkina A, Gai MJ, et al. Cost-effectiveness of emerging antibiotic strategies for the treatment of drug-use associated infective endocarditis. Presented at: IDWeek; September 29 to October 3, 2021.Poster 58.

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