Daptomycin a ‘suitable alternative’ to vancomycin for OPAT
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Key takeaways:
- Daptomycin costs more to acquire, but the overall treatment cost is less than with vancomycin.
- Daptomycin requires less monitoring, once-daily dosing and has fewer potential side effects.
Although daptomycin remains more expensive than vancomycin, it is a “suitable alternative” to daptomycin for outpatient parenteral antimicrobial therapy because it results in less health care utilization, researchers reported.
“Working in outpatient parenteral antimicrobial therapy (OPAT), I see firsthand the complex coordination required for patients receiving vancomycin,” Amber C. Streifel, PharmD, an OPAT pharmacist at Oregon Health & Science University, told Healio.
“I wondered if those costs start to balance out if you factor in the additional labs and time needed for coordination,” she said.
According to Steifel, although the price of daptomycin has gone down since a generic version of the drug was introduced in 2016, it remains more expensive than vancomycin.
Streifel and colleagues performed a retrospective cohort study of 409 people who received vancomycin (n = 290) and daptomycin (n = 119) via infusion either at home, at an infusion center or a skilled nursing facility between Jan. 1, 2017, and May 20, 2022, through the OPAT program at Oregon Health & Science University.
The most common condition in both groups was bone and joint infection (64% vancomycin and 62% daptomycin) and the most common pathogen was MRSA (36% vancomycin and 40% daptomycin), with the vancomycin group also having a significantly higher proportion of comorbid coronary artery disease, according to the study.
Overall, the price to acquire daptomycin was more than 2 1/2 times higher than vancomycin ($744.24 vs. $289.29), but when the researchers factored in the cost of interventions, dose adjustments, additional laboratory monitoring and line complications, the cost of a course of daptomycin ($996.76) was more than 25% lower than a course of vancomycin ($1,351.98).
Roughly half the patients in the vancomycin group had Medicare compared with about one-third in the daptomycin group, and although daptomycin was more likely to be used in home infusion (62% vs. 47%), vancomycin was used much more often in skilled nursing home situations (44% vs. 13%).
Additionally, compared with those receiving vancomycin, patients receiving daptomycin had fewer laboratory events requiring intervention, rates of additional interventions and phones, and fewer patients switched to another antibiotic during their OPAT course, according to the study.
Streifel said daptomycin should be considered more often for patients’ sake.
“In addition to clinical considerations, it’s important to also consider the burden of treatment with vancomycin for patients receiving this antibiotic for OPAT,” Streifel said.
References:
- Adamu Y, et al. PLoS One. 2024;doi:10.1371/journal.pone.0293423.
- Streifel AC, et al. Open Forum Infect Dis. 2024;doi:10.1093/ofid/0fae438.
- Teva strengthens injectables portfolio with the launch of an authorized generic of Cubicin (daptomycin for injection) in the United States. https://www.tevapharm.com/news-and-media/latest-news/teva-strengthens-injectables-portfolio-with-the-launch-of-an-authorized-generic-of-cubicin-daptomycin-f/. Published Sept. 15, 2016. Accessed Aug. 8, 2024.
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