Evaluation of Home versus Hospital Intravenous Antibiotic Treatment for Spondylodiscitis Patients under the Pilot Value-based Model at the Department of Infectious Diseases Copenhagen University Hospital

Abstract

Concern regarding the rising cost of hospital-based intravenous antibiotic treatment for patients with infectious diseases has increased interest among health decision-makers in exploring alternatives in outpatient and home settings. Home IV AB treatment for spondylodiscitis patients is a safe alternative to hospitalization, which can reduce hospital costs by half without compromising health outcomes. The objective of this thesis is to analyze the implementation of the home IV AB treatment under the valuebased model and provide evidence as to whether home treatment is an economically preferable alternative compared to hospital-based treatment at the Department of Infectious Diseases at Copenhagen University hospital. This Master’s thesis follows a Health Technology Assessment model based on the following four elements: organization, patient, technology, and economy. We pay particular focus to two elements: organization and economy. For the organization element, we use qualitative methods to explore the organizational aspects at the macro and micro level. The economic element of this thesis responds to an economic evaluation of the home treatment program. We use a decision-analytic model to explore the economic impact of the home treatment program, and conduct a cost analysis of the home and hospital-based treatments to determine the financial consequences of the intervention. Based on our findings, we recommend an integrated team approach, assiduous patient monitoring, outcome measurement, structured planning, efficient resource allocation and training to guarantee the success of home treatment programs. We propose key recommendations to strengthen the implementation of the home treatment prior to broader implementation in other departments at the hospital. The results of the preliminary data of the home treatment pilot at the Department of Infectious Diseases found that home treatment is a cost-saving option for the hospital. Moreover, it is a viable, safe, effective alternative compared to hospitalization, with positive experiences for the patients. This thesis is intended to inform clinicians, hospital administration, and policymakers interested in gaining knowledge about the drivers of implementation and economic feasibility of home treatment programs. The analysis and results of this thesis provide evidence for the appraisal of home treatments under the value-based management. Moreover, the strategies in this study can be used for other groups of infectious disease patients, since the home treatment program was considered suitable for other departments at Copenhagen University Hospital. Nevertheless, even though home treatment is a costsaving alternative, decision-makers still need to take into account the heterogeneity of patient groups and variables that affect the outcomes of the treatment.