Given the high cost of hospital (inpatient) stays, antibiotics that are convenient for use in the outpatient setting and can thus avoid hospitalization and/or that can reduce the number of inpatient days have become increasingly attractive treatment options for both healthcare providers and payers. Antibiotics with available oral formulations, interchangeable IV and oral formulations, or convenient dosing schedules and administration have experienced uptake in the outpatient setting. Due to its potential to reduce healthcare costs, improve convenience, and decrease the risk of hospital-related complications, outpatient parenteral antibiotic therapy (OPAT)—a segment of the outpatient market—has become a widespread practice in the United States, particularly for management of chronic infections or infections that necessitate long treatment courses but carry a relatively low risk of fulminant disease, such as complicated skin and skin structure infections (cSSSIs; e.g., diabetic foot infections) and osteomyelitis (OM). Antibiotic choices are driven mainly by spectrum of activity, particularly activity against methicillin-resistant Staphylococcus aureus (MRSA), less frequent dosing (e.g., once daily), safety, and reimbursement coverage. OPAT has already become an important contributor to the overall growth of several marketed antibiotics (e.g., Cubist’s Cubicin [daptomycin]); however, the anticipated launch of two new therapies—Durata’s dalbavancin and The Medicines Company’s oritavancin—will likely have a major impact on current dynamics of the MRSA OPAT market. Both are second-generation lipoglycopeptides in late-stage clinical development for treatment of acute bacterial skin and skin structure infections; both agents offer the convenience of less frequent dosing (once-weekly dosing for dalbavancin and single-dose therapy for oritavancin) and are likely to see favorable uptake and use by physicians as OPAT for cSSSIs and OM.
For this report, we surveyed 100 office-based and hospital-based infectious diseases (ID) specialists to analyze current and future prescribing practices, commercial drivers of current therapies, and the opportunities for emerging therapies targeting outpatient treatment of cSSSIs and OM. We also surveyed 30 MCO pharmacy and medical directors for their viewpoints on reimbursement decisions for antibiotics used in OPAT and other reimbursement-related factors influencing physicians’ prescribing of OPAT for cSSSIs and OM in the United States.
This U.S. Physician & Payer Forum report contains insights from a survey of 100 ID specialists and 30 MCO pharmacy and medical directors regarding current and future prescribing practices, commercial drivers of current therapies, opportunities for emerging therapies—namely Durata’s dalbavancin and The Medicine Company’s oritavancin—as well as payers’ viewpoints on reimbursement decisions for antibiotics used in OPAT and measures to constrain utilization and reduce costs.
Markets covered: United States.
Primary research: Online survey of 100 hospital- and office-based ID specialists, 20 MCO pharmacy directors, and 10 MCO medical directors.