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Hosp Pediatr. 2019 Apr;9(4):234-240. doi: 10.1542/hpeds.2018-0193.

Economic Burden of Home Antimicrobial Therapy: OPAT Versus Oral Therapy.

Author information

Infectious Disease, Department of Pediatrics, School of Medicine and.
Divisions of Epidemiology and.
Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah.
Informatics, Decision-Enhancement and Analytic Sciences Center, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.
Intermountain Homecare Pharmacy, Intermountain Healthcare, Salt Lake City, Utah; and.
College of Medicine, Texas A&M University, Bryan, Texas.
Infectious Disease, Department of Pediatrics, School of Medicine and



There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. Our objective was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL).


We conducted a prospective cohort study of caregivers for children after hospitalization who were treated with prolonged antimicrobial therapy. We collected data about missed work and school and time spent administering therapy. Caregivers completed the Pediatric Quality of Life Inventory to assess QoL. Clinical information included length of stay, treatment indication, and type of therapy (OPAT versus oral therapy). Direct medical costs were obtained by using a microcosting system and accounted for medication, supplies, and home-nursing visits. The primary cost outcome was the mean daily cost of therapy. Multivariable models were developed to adjust for potential confounders.


Two hundred and twelve caregivers completed surveys: 123 (58%) for oral therapy and 89 (42%) for OPAT. Caregivers administering OPAT reported more missed work, missed school for their children, time with daily medication administration (90 vs 6 minutes; P < .01) and lower QoL scores (77.8 vs 68.9) than caregivers administering oral therapy. The mean daily cost was $65 (95% confidence interval: $51-$78) for OPAT and $7 (95% confidence interval: $4-$9) for oral therapy. Relative differences in cost and QoL between groups did not change after model adjustment.


The overall burden of OPAT is substantially higher than that of oral therapy, including higher direct and indirect costs and greater impact on caregiver QoL. These findings strongly support efforts to use oral therapy in place of OPAT when clinically appropriate.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Byington has intellectual property and receives royalties from BioFire Diagnostics; the other authors have indicated they have no potential conflicts of interest to disclose.

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