TREATING METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS WITH VANCOMYCIN IN A HOME INFUSION THERAPY SETTING JOSHUA WEBB*, MS DENNIS EMMETT, DBA ALBERTO COUSTASSE, DR.PH, MD, MBA, MPH GRADUATE SCHOOL OF MANAGEMENT COLLEGE OF BUSINESS MARSHALL UNIVERSITY

Introduction  Risk of Infection in Hospitals is a Problem.  MRSA – Easily classified as an epidemic in many U.S. Hospitals.  Increase of 62% of MRSA related infections of between 1999 and  2005 – Estimated 94,360 hospitalized patients infected with MRSA.  MRSA for Hospitals is a Problem.  Prolongs hospitalizations and increases morbidity.  Costs U.S. hospitals an estimated $3.2 billion - $4.2 billion annually. Direct result of prolonged hospitalizations due to MRSA infections.

Introduction  Medicare Expenditures*  Hospitalization (Part A): $129.1 Billion.  Advantage Plans (Part C): $92.8 Billion.  Physician & Supplies (Part B): $88.1 Billion.  Home Health: $16.5 Billion.  Out-Patient Services: $20.9 Billion. * 2008 – Medicare Expenditures

Introduction  A Potential Solution – Home Infusion Therapy (HIT)  Home Infusion Therapy: Administration of Intra Venous (IV) medicines and therapy in the patient’s home as an alternative to receiving the same treatment in a hospital setting.  Is becoming more prevalent as Managed Care emerges: 2010: $11Billion in net revenues. 2010: 700-1,000 HIT providers in the U.S.

Introduction  Treating MRSA in Hospitals: Costs between $22,000 - $49,000 for entire treatment. Average daily cost of $798 High risk of spreading infection.  Treating MRSA in Home Infusion Setting Costs between 77%-85% less than hospital setting. Average daily cost of $122 91% positive clinical outcome: Successful completion of therapy without complications

Introduction  Purpose of this Research Study:  Analyze treatment of MRSA in a Home infusion therapy Pharmacy.  Focusing on the following: Financial Implications. Clinical Outcomes. Treatment Duration. Benefits in HIT as an alternative to Hospital.

Methodology  Sample Population : Convenience sample  60 cases of Patients being treated for MRSA Non-identifiable data. Mid West Home Infusion Pharmacy. Using the drug Vancomycin. Patients treated between All insurance types included.

Methodology  Data Collection & Instruments  Patient Age: 60 years and Older. Younger than 60 years.  Diagnosis: MRSA Only/ MRSA + Secondary Diagnosis.  Insurance Type: Medicare, Medicaid, Commercial, Workers Comp., Private Pay.  Treatment Duration: Cost of treatment per day. Days of Therapy.

Results Total Population: 33 Males (55%) and 27 Females (45%). Mean Age = 56.1 Range =  60 years and older: N=26 (43%). Mean Age = Range =  Younger than 60 years: N=34 (57%). Mean Age = Range =

Results Table 1: Secondary Diagnosis of Patients with MRSA Receiving Home IV Vancomycin Aged ≥ 60 (N=26)Aged < 60 (N=34)Total (N=60) Secondary Diagnosis Cases N (%) Bacteremia2 (7.5)3 (9)5 (8) Carbunkle0 (0)1 (3)1 (2) Cellulitius1 (4)6 (17)7 (12) E.Coli0 (0)1 (3)1 (2) Epidural Abscess1 (4)1 (3)2 (3) Infected Pacemaker1 (4)0 (0)1 (2) Osteomyelit5 (19)2 (6)7 (12) Post Operation Infections2 (7.5)0 (0)2 (3) Pseudomonas Infection1 (4)2 (6)3 (5) Septic Joint1 (4)1 (3)2 (3) Urinary Tract Infection1 (4)2 (6)3 (5)

Results Table 2: Treatment Duration of Patients Receiving Home IV Vancomycin Aged ≥ 60 (N=26) Aged < 60 (N=34) Total (N=60) Mean Treatment Duration N (days) MRSA11 (21.5)15 (19.1)26 (19.4) MRSA + Secondary Diagnosis15 (29.1)19 (30.9)34 (30.1) Total 26 (25.9) 34 (25.1) 60 (25.5)

Results Table 3: Adverse Events of Patients Receiving Home IV Vancomycin Aged ≥ 60 (N=26)Aged < 60 (N=34)Total (N=60) Adverse Events, N (%) Infected PICC Line 1 (4)1 (3)2 (3) Hospitalized1 (4)1 (3)2 (3) Non-Comply0 (0)1 (3)1 (2) No Adverse Events 24 (92)31 (91)55 (92)

Results Table 4: Mean Cost Per Day of Patients Receiving Home IV Vancomycin Aged ≥ 60 (N=26) Aged < 60 (N=34) Total (N=60) Average Cost Per Day MRSA Only MRSA + Secondary Diagnosis Total

Discussion  Dalovisio, et al. (2000): Patient Cases – 2. HIT Cost-Per-Day Average: $ Positive Clinical Outcome: 91% 4. Hospital Cost-Per-Day Average: $798  This study: Patient Cases – 2. HIT Cost-Per-Day Average: $ Positive Clinical Outcome: 92% 4. Hospital Cost-Per-Day: not performed

Discussion  Cost-Per-Day Analysis  Patients in the older age group presented a lower cost than patients in the younger age group.  Cost-Per-Day: MRSA +Secondary Diagnosis Group Older age group – Lower average than total population Younger age group –slightly higher average than total population

Discussion  Clinical Outcome Analysis  Both groups experienced higher treatment duration when being treated for MRSA + secondary diagnosis.  No substantial difference in Positive Clinical Outcomes when divided into age groups: 60 years and older – 92% Younger than 60 – 91%

Conclusion  Results of this research study yielded to supporting evidence with current published literature in this topic.  Coverage of HIT under Fee-For-Service Medicare can reduce hospitalization expenditures.  More in-depth research should be conducted with the long-term financial benefits of HIT coverage through Fee-For-Service Medicare.

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