U.S. Physician and Payer Forum

November 2013

How Will the Anticipated Availability of Once-Weekly Antibiotics Affect Current Practices in the Outpatient Treatment of Skin Infections and Osteomyelitis?

Report Authors
Hannah E. Cummings, Ph.D.

Introduction:

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.

Questions Answered in This Report:

  *   Understand current prescribing practices and future treatments trends for OPAT of cSSSIs and OM. What factors currently limit the initiation of OPAT? What factors are its main drivers? What are the key drivers for the prescribing of current major antibiotic brands as OPAT? What percentage of cSSSI and OM patients receive OPAT? In what settings do cSSSI and OM patients typically receive OPAT? What are the most common causative pathogens observed in cSSSIs and OM? Which currently marketed antibiotics are likely to see increased use as OPAT in the near future?

  *   Examine reimbursement of current OPAT therapies, criteria for initiation of OPAT, and patient eligibility. What is the reimbursement status of key current IV antibiotics for OPAT among surveyed plans? How important is cost of therapy in reimbursement decisions for outpatient IV antibiotics? Does site of OPAT administration (e.g., infusion center, home-based) and indication type influence reimbursement decisions for OPAT and how? How often are drug-quantity limits, OPAT visit limits, co-pays, and co-insurance employed by MCOs to restrict the use of OPAT drugs? What prescribing criteria need to be met to satisfy prior authorization requirements for antibiotic use as OPAT?

  *   Explore physicians’ and payers’ perceptions of emerging therapies. What percentages of ID specialists anticipate prescribing dalbavancin and/or oritavancin as OPAT for cSSSIs and OM? What are physicians’ and payers’ perceptions of dalbavancin’s and oritavancin’s long half-lives, which allow for less frequent dosing? Which current therapies are most likely to be replaced by emerging therapies in the OPAT setting? How do physicians and payers perceive the competitive potential of dalbavancin and oritavancin?

Scope:

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.


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