Cost-Savings and Length of Stay Reduction Associated with Early Switch from Intravenous to Oral Antibiotics Within 48 Hours of Clinical Stability

Abstract

Switching from intravenous to oral antibiotic therapy within 48 hours of clinical stability can yield substantial cost savings and shorten the length of stay. A prospective cohort study examined the hospital and payer costs associated with an early switch from intravenous to oral antimicrobials compared to a late switch or continued intravenous therapy in patients who received appropriate therapy and met pre-specified criteria for transition. Among 160 patients, the mean length of stay from the start of effective therapy was 11.8 days for the early-transition group and 14.5 days for the continuation group. Hospital costs per case averaged €20,619 for the early-transition strategy and €21,207 for continuation, representing a mean incremental saving of €588 (95% confidence interval −5,262–6,692) from the hospital perspective. The corresponding payer savings were €4,122 (95% confidence interval −1,865–10,979). Early switching was further supported by sensitivity analyses applying alternative definitions of clinical stability and considering different antibiotic classes. Although not mandatory, transitioning to oral antimicrobials by 48 hours of stability decreased both costs and length of stay compared to continual intravenous therapy among hospitalised patients deemed clinically stable in line with international guidelines (Gasparetto et al., 2019).