Outpatient antibiotics improve care for drug use-associated infective endocarditis
Click Here to Manage Email Alerts
Outpatient antibiotics improved outcomes for patients with injection drug use-associated infective endocarditis compared with patients who received inpatient IV therapy, according to a study.
Between 2003 and 2016, hospitalizations associated with infective endocarditis increased from 16 per 100,000 adults in to 22 per 100,000 adults, and 10% of the hospitalizations are now a result of injection drug use, according to Joëlla W. Adams, PhD, a researcher at Boston Medical Center, and colleagues.
“This increase has largely been associated with the opioid epidemic, specifically the injection of heroin and fentanyl,” they wrote in JAMA Network Open. “If current patterns continue, more than 250,000 individuals in the U.S. may die of [injection drug use–associated infective endocarditis (IDU-IE)] between 2020 and 2030.”
Adams and colleagues said there is a “substantial need” to define optimal treatment strategies, given the increasing burden of IDU-IE in the U.S.
To investigate the efficacy of outpatient treatment for infective endocarditis, they created a model that simulated the natural history of injection opioid use among 5 million people. According to the study, they compared life expectancies, rates of treatment completion, endocarditis and overdose deaths and average costs for four treatment strategies.
Two treatment strategies offered the standard 4 to 6 weeks of inpatient IV antibiotics, either with or without inpatient addiction care services. The other two provided 3 weeks of inpatient IV antibiotics and addiction care services, followed by either outpatient IV or oral antibiotics.
Whereas the study demonstrated that the usual care strategy resulted in 18.63 life years (LYs) at a cost of $416,570 per person, with 77.6% of hospitalized patients completing treatment, it also showed that the alternative strategies extended life expectancy.
According to researchers, the partial oral antibiotic strategy yielded the highest treatment completion rate (80.3%) compared with the outpatient parenteral antimicrobial therapy (OPAT) strategy (78.8%) and the usual care/addiction care strategy (77.6%). Study data also showed that the OPAT strategy was the least expensive at $412,150 per person. Compared with the OPAT strategy, the partial oral antibiotic strategy had an incremental cost-effectiveness ratio of $163,370 per LY.
Based on the findings, the researchers suggested that the strategies could save the health care system more than $6 billion in hospitalizations for the estimated 750,000 Americans who inject drugs.
“Outpatient treatment approaches for endocarditis may not only save lives, but also save money that could then be allocated to evidence-based programs for the opioid crisis,” Joshua A. Barocas, MD, associate professor of medicine at the University of Colorado School of Medicine, said in a press release. “These strategies include promoting safer injection and other harm reduction techniques, improving access to medications for opioid use disorder, and funding outpatient support systems.”
He added, “This would allow people who use drugs to not only heal from endocarditis but do so in a way that they can more easily return to work, to life and to family.”
References:
Take-home antibiotic therapies may improve health outcomes, lower costs, for patients with drug use-associated infective endocarditis. https://www.nih.gov/news-events/news-releases/take-home-antibiotic-therapies-may-improve-health-outcomes-lower-costs-patients-drug-use-associated-infective-endocarditis. Published Feb. 28, 2022. Accessed March 1, 2022.
Collapse
Read more about
Click Here to Manage Email Alerts