Background Dalbavancin (DBV) is an antibiotic from the lipoglycopeptide family that is active against Gram +cocci (GPC) that reaches adequate concentrations to allow dosing once a week. It is currently only approved for skin and soft tissue infections, although its PK/PD properties could allow a potential use for infectious endocarditis (IE) and/or bloodstream infections caused by GPC. The estimated duration of bloodstream infections is 10 to 14 days and 28 to 42 days for IE, both requiring intravenous treatments and prolongued hospital stay, all of which entails a high use of hospital and economic resources.
Purpose The purpose of this study was to evaluate the economic impact of switching to dalbavancin from standard antibiotic treatment
Material and methods Observational,restrospective,single-centre study. All patients with IE and/or bloodstream infections caused by GPC who had received at least one dose of DBV were included. The proportion of patients presenting clinical resolution was calculated, as well as the reduction in days of hospital stay and associated costs. For the estimate of reduction of costs, public prices provided by the health system were used.
Results Thirty patients were included: 22 (73.3%) were males,with a median age of 66 (IQR 47.5–75.5),Charlson Index 1 (IQR 1–3). Twenty-two patients (73.3%) had IE and 8 (26.7%) had a bloodstream infection. The isolated microbiological agent was coagulase-negative staphyloccoci in 46.7% of patients; 13.3% streptococus spp, 10% enterococcus spp; and 10% SAMS y 3.3% SAMR. The reason for administering DBV was: 83.3% early discharge, 10% failure of previous treatment and 6.6% toxicity. The median length of stay was 27 (IQR 18–38) days. The initial dose of DBV was 1500 mg in 21 (70%) patients;1000 mg in eight (26.7%) patients and in one patient the dose was 750 mg adjusted for renal function. Four patients (13.3%) received an extra dose of 1000 mg on day 14. 73.3% of patients had previously received treatment with daptomycin, and 24 (80%) presented clinical resolution at the time of the analysis. Hospital stay was reduced in 24 (80%) patients by a median of 11 days (IQR 1–14), leading to average savings of €6830.96 per patient. The average cost of treatment with dalbavancin was €1341.9 compared to €1475.63 for 14 days of treatment with daptomycin (€133.73).
Conclusion In conclusión, the administration of DBV for patients with a positive clinical evolution could be an effective alternative treatment, with an important reduction in health costs.
No conflict of interest