Outpatient management, skipping redundant tests help cut cost of treating SSTIs

Inpatient management of skin and soft tissue infections (SSTIs) often uses substantial healthcare resources, but identification of outpatient candidates and avoidance of tests with low diagnostic capacity can reduce the economic burden of SSTIs, suggests a study.

A total of 252 adult patients hospitalized in 2015 for SSTIs who received >24 hours of antimicrobials were included in this retrospective study. The CREST+SEWS scoring system was used to categorize patients into class I to IV.

The authors then performed a budget impact analysis on CREST+SEWS class I patients to compare the medical costs of current treatment in the inpatient setting with intravenous antibiotics, with a proposed alternative of using oral antibiotics in the outpatient setting. They obtained pharmacy and medical costs and resources related to inpatient management of class I SSTIs from the itemized discharge records.

Sixty-one (24 percent) of the included patients were stratified into class I. The total cost of treating class I patients with SSTI in the inpatient setting was USD 281,816 in 2015, or USD 4,619 per patient. In theory, treatment with oral antibiotics in the outpatient setting would result in cost savings estimated to be USD 4,398 per patient.

In addition, 53 percent of the patients had blood cultures, and each patient underwent two radiographic tests on average.

“The CREST+SEWS score categorizes patients with SSTIs into four severity classes,” the authors said. “Hospitalizations can be avoided in class I as they are treated as outpatients with oral antibiotics, whereas class IV require hospitalization for intravenous antibiotics.”