{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:09:47Z","timestamp":1793912987375,"version":"4.8.0"},"reference-count":18,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T00:00:00Z","timestamp":1632787200000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,15]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare costs associated with different models of outpatient parenteral antimicrobial therapy (OPAT) delivery with costs of inpatient (IP) care across key infection groups managed via OPAT in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cost-minimisation design was used due to evidence of similarities in patient and treatment outcomes between OPAT and IP care. A bottom-up approach was undertaken for the evaluation of OPAT associated costs. The British Society of Antimicrobial Chemotherapy National Outcomes Registry System was used to determine key infection diagnoses, mean duration of treatment and most frequent antibiotics used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Several OPAT delivery settings were considered and compared with IP care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>OPAT models considered were OP clinic model, nurse home visits, self (or carer)-administration by a bolus intravenous, self-administration by a commercially prefilled elastomeric device, continuous intravenous infusion of piperacillin with tazobactam or flucloxacillin with elastomeric device as OP once daily and, specifically for bone and joint and diabetic foot infections, complex outpatient oral antibiotic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Base case and a range of scenario results showed all evaluated OPAT service delivery models to be less costly than IP stay of equivalent duration. The extent of savings varied by OPAT healthcare delivery models. Estimated OPAT costs as a proportion of IP costs were estimated at 0.23\u20130.53 (skin and soft-tissue infections), 0.34\u20130.46 (complex urinary tract infections), 0.23\u20130.51 (orthopaedic infections), 0.24\u20130.42 (diabetic foot infections) 0.40\u20130.56 (exacerbations of bronchiectasis) and 0.25\u20130.42 (intra-abdominal infections). Partial or full complex oral antibiotic therapies in orthopaedic or diabetic foot infections costs were estimated to be 0.13\u20130.26 of IP costs. Main OPAT costs were associated with staff time and antimicrobial medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OPAT is a cost-effective use of National Health Service resources for the treatment of a range of infections in the UK in patients who can be safely managed in a non-IP setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-049733","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:48:10Z","timestamp":1632876490000},"page":"e049733","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":70,"title":["Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses"],"prefix":"10.1136","volume":"11","author":[{"given":"Maria","family":"Dimitrova","sequence":"first","affiliation":[{"name":"Scottish Health Technology Group, Healthcare Improvement Scotland, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gilchrist","sequence":"additional","affiliation":[{"name":"Department of Infection\/Pharmacy, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2509-0597","authenticated-orcid":false,"given":"R A","family":"Seaton","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK"},{"name":"Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,28]]},"reference":[{"key":"2025121407443085000_11.9.e049733.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f1585"},{"key":"2025121407443085000_11.9.e049733.2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlz026"},{"key":"2025121407443085000_11.9.e049733.3","unstructured":"British Society for Antimicrobial Chemotherapy . National outcomes registry system (NORS), c2019. Available: https:\/\/www.e-opat.com\/opat-registry\/"},{"key":"2025121407443085000_11.9.e049733.4","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1093\/jac\/dku541","article-title":"How is income generated by outpatient parenteral antibiotic treatment (OPAT) in the UK? analysis of payment tariffs for cellulitis","volume":"67","author":"Jones","year":"2015","journal-title":"J Antimicrob Chemother"},{"key":"2025121407443085000_11.9.e049733.5","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1093\/jac\/dkz122","article-title":"From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection","volume":"74","author":"Seaton","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2025121407443085000_11.9.e049733.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013560"},{"key":"2025121407443085000_11.9.e049733.7","doi-asserted-by":"crossref","DOI":"10.1111\/ijcp.13216","article-title":"Safety and effectiveness of 'hospital in the home' and 'outpatient parenteral antimicrobial therapy' in different age groups: A systematic review of observational studies","author":"Sriskandarajah","year":"2018","journal-title":"Int J Clin Pract"},{"key":"2025121407443085000_11.9.e049733.8","first-page":"02","article-title":"The community intravenous antibiotic study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy","volume":"02","author":"Minton","year":"2017","journal-title":"NIHR Journals Library Health Services and Delivery Research"},{"key":"2025121407443085000_11.9.e049733.9","doi-asserted-by":"publisher","DOI":"10.1136\/ejhpharm-2018-001515"},{"key":"2025121407443085000_11.9.e049733.10","article-title":"Assessment of the stability of citrate-buffered piperacillin\/tazobactam for continuous infusion when stored in two commercially available elastomeric devices for outpatient parenteral antimicrobial chemotherapy: a study compliant with the NHS yellow cover document requirements","author":"Jamieson","year":"2020","journal-title":"Eur J Hosp Pharm"},{"key":"2025121407443085000_11.9.e049733.11","unstructured":"PSSRU . 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Reference costs: 2019-20 reference costs collection, 2020. 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