Abstract：
BACKGROUND: The treatment of acute bacterial skin and skin structure infections (ABSSSI) usually involves intravenous (i.v.) antibiotics requiring hospitalisation and increasing hospital costs. Since 2014, dalbavancin is approved for ABSSSIs treatment. However, evidence of its health economic impact on the German healthcare system is still limited.
METHODS: Diagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting \'Einheitlicher Bewertungsmaßstab\' (EBM) codes were evaluated.
RESULTS: This retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD -10th revision) code A46 \'erysipelas\'. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case.
CONCLUSIONS: Dalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS.
METHODS: Diagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting \'Einheitlicher Bewertungsmaßstab\' (EBM) codes were evaluated.
RESULTS: This retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD -10th revision) code A46 \'erysipelas\'. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case.
CONCLUSIONS: Dalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS.
摘要：
背景：急性细菌性皮肤和皮肤结构感染（ABSSSI）的治疗通常涉及静脉（i.v.）抗生素，需要住院治疗并增加住院费用。自2014年以来，达巴万辛被批准用于ABSSSI治疗。然而,其对德国医疗系统的健康经济影响的证据仍然有限。
方法：使用基于诊断相关组（DRG）的成本分析来评估来自德国三级护理中心的真实世界数据（RWD）。包括在科隆大学医院皮肤性病科接受静脉内抗生素治疗的所有患者，以从付款人的角度检测潜在的成本节省。因此，对于住院护理德国诊断相关团体(G-DRG)关税，停留时间(LOS)评估了主要和次要DRG诊断以及门诊设置的“EinheitlicherBewertungsmaβstab”（EBM）代码。
结果：这项回顾性研究确定了2016年1月至2020年12月期间接受ABSSSI治疗的480例住院病例。有433例患者的完整费用数据，根据超出LOS上限的附加费检测长期住院患者导致125例（29％），包括67例女性（54％）和58例男性（46％），总体平均年龄为63.6岁；所有患者均接受国际疾病分类（ICD-第10次修订）代码A46“丹毒”治疗。一项针对DRGJ64B的子分析共92例超过LOS上限3天，导致每例附加费中位数为636欧元（平均值749欧元；SD589欧元；IQR459欧元-785欧元）。相比之下,我们计算的门诊治疗费用约为每例55欧元.因此，在超过LOS上限之前,在门诊对这些患者进行进一步治疗可能导致每例约581欧元的成本节约潜力.
结论：Dalbavancin似乎是一种具有成本效益的选择，通过将ABSSSI可能超过LOS上限的患者过渡到门诊来降低住院治疗成本。
方法：使用基于诊断相关组（DRG）的成本分析来评估来自德国三级护理中心的真实世界数据（RWD）。包括在科隆大学医院皮肤性病科接受静脉内抗生素治疗的所有患者，以从付款人的角度检测潜在的成本节省。因此，对于住院护理德国诊断相关团体(G-DRG)关税，停留时间(LOS)评估了主要和次要DRG诊断以及门诊设置的“EinheitlicherBewertungsmaβstab”（EBM）代码。
结果：这项回顾性研究确定了2016年1月至2020年12月期间接受ABSSSI治疗的480例住院病例。有433例患者的完整费用数据，根据超出LOS上限的附加费检测长期住院患者导致125例（29％），包括67例女性（54％）和58例男性（46％），总体平均年龄为63.6岁；所有患者均接受国际疾病分类（ICD-第10次修订）代码A46“丹毒”治疗。一项针对DRGJ64B的子分析共92例超过LOS上限3天，导致每例附加费中位数为636欧元（平均值749欧元；SD589欧元；IQR459欧元-785欧元）。相比之下,我们计算的门诊治疗费用约为每例55欧元.因此，在超过LOS上限之前,在门诊对这些患者进行进一步治疗可能导致每例约581欧元的成本节约潜力.
结论：Dalbavancin似乎是一种具有成本效益的选择，通过将ABSSSI可能超过LOS上限的患者过渡到门诊来降低住院治疗成本。
