Pharmacoeconomic considerations in the ambulatory use of parenteral cephalosporins.

It has been clearly documented that outpatient parenteral antibiotic therapy (OPAT) saves money compared with hospital care for patients who need intravenous antimicrobial therapy. The reduced expenses come primarily from savings in facility and hospital staffing costs. In addition to shortening hospital stay, OPAT programmes can be developed so that hospital care is avoided altogether. However, even with the clear potential for savings, to have a successful programme it is necessary to align the interests of the payers, the physicians, the administrators and the patients. The cost of OPAT programmes can also be reduced through patient evaluation and careful selection of the appropriate delivery model, antibiotic, dosage intervals and infusion technology. The fact that antibiotics such as ceftriaxone, the aminoglycosides and vancomycin can be given once daily in the elderly offers particular advantages in terms of convenience as well as cost. In order to achieve cost savings, managed care will increasingly rely on home and outpatient therapy. This pressure will need to be counterbalanced by quality assurance programmes and outcomes measurements.