Are Oritavancin and Dalbavancin More Cost Effective for Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Medical Center?

Background: Dalbavancin and oritavancin are long-acting lipoglycopeptides frequently used off-label to avoid outpatient parenteral antimicrobial therapy or placement of a central line at hospital discharge for patients with infections. Although dalbavancin and oritavancin have higher acquisition costs compared with commonly used antibiotics, such as vancomycin and daptomycin, they may reduce overall cost of health care. Methods: This single-center, retrospective, cost-minimization analysis compared treatment with oritavancin and dalbavancin vs vancomycin and daptomycin. Adult patients treated with oritavancin or dalbavancin between September 2017 and November 2022 were matched by indication to patients who received vancomycin or daptomycin. Costs were calculated using a decision tree base model. Results: Fifty-five patients were included in the analysis: 22 received oritavancin, 15 received dalbavancin, 10 received vancomycin, and 8 received daptomycin. The mean cost of therapy per patient receiving oritavancin, dalbavancin, vancomycin, and daptomycin was $35,630, $59,612, $73,333, and $73,708, respectively. Conclusions: The cost of using oritavancin and dalbavancin was lower than that of vancomycin and daptomycin, especially for osteomyelitis. As safety and effectiveness data continue to emerge, the use of long-acting lipoglycopeptides appears to be an increasingly attractive alternative to traditional outpatient antimicrobial therapy.