Resource Over-Utilization in Hospitalized Patients With Uncomplicated Skin and Soft Tissue Infections. (October 2022)

• Record Type: Journal Article
• Authors: Venugopalan, Veena; Crawford, Robert; Ho, Kennedy; Garg, Mahek; Park, Haesuk; Premraj, Sasha; Klinker, Kenneth; Cherabuddi, Kartikeya; DeSear, Kathryn
• Is Part Of: Journal of pharmacy practice. Volume 35:Number 5(2022)
• Page Start: 675
• Page End: 679
• Publication Date: 2022-10
• Subjects: skin and soft tissue infections -- cost-minimization; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/08971900211000216
• Languages: English
• ISSNs: 0897-1900

Abstract

Background: Inpatient management of SSTIs utilizes considerable healthcare resources. The CREST+SEWS score categorizes patients with SSTIs into 4 severity classes. Hospitalizations can be avoided in Class I as they are treated as outpatients with oral antibiotics, whereas Class IV require hospitalization for intravenous antibiotics. Objective: The purpose of this study was to perform a budget impact analysis on CREST+SEWS Class 1 patients, to compare the medical costs of current treatment, in the inpatient setting with intravenous antibiotics, with a proposed alternative of using oral antibiotics in the outpatient setting. Further, resource utilization in Class I was evaluated. Methods: This was a retrospective study of adult patients hospitalized in 2015 for SSTIs who received >24 hours of antimicrobials. The CREST+SEWS scoring system was used to stratify patients into Class I to IV. Pharmacy and medical costs and resources associated with inpatient management of Class I SSTIs were derived from the itemized discharge records. Results: Of the 252 patients who met the inclusion criteria, 61 (24%) were classified as Class I. The total cost of treating Class I SSTI patients in the inpatient setting was $281, 816 (cost per patient: $4, 619) in 2015 USD. In the hypothetical situation of treatment with oral antibiotics in the outpatient setting, the cost savings were estimated to be $4, 398 per patient. Fifty-three percent of patients had blood cultures, and on average, each patient received 2 radiographic tests. Conclusions: Identifying outpatient candidates, and avoiding tests with low diagnostic can reduce the economic burden of SSTIs.