Title: Lipoglycopeptides Unleashed: The Power of Dalbavancin and Oritavancin
Authors: Michael Wallace, Heather Gibson, Gretchen Arnoczy, Allison Cid
Background: Lipoglycopeptides are newer antimicrobial agents used to treat gram positive bacterial infections that would otherwise require long term therapy. Advantages include less frequent dosing, no need for pharmacokinetic monitoring, and long half-lives. The long-acting effects of dalbavancin or oritavancin are useful to help prevent patients from needing long-term intravenous access for IV antibiotics and hospital admission. The purpose of this study was to compare the costs between dalbavancin and oritavancin use compared to traditional therapy for gram-positive infections. Methods: This was a retrospective, multicenter cohort study at a rural, community health system that included patients who received either dalbavancin or oritavancin at an outpatient infusion center. Patients were included if they received dalbavancin or oritavancin from September 2022 to September 2025. Excluded patients were those that are incarcerated, pregnant women, those younger than 18 years old, or received dalbavancin or oritavancin inpatient. The primary outcome of the study was cost minimization with comparisons between oritavancin and dalbavancin and the standard treatment for gram-positive infections. Secondary outcomes included adverse events, clinical failure, and mortality. Clinical characteristics such as organism, type of infection, and rationale for dalbavancin or oritavancin use were recorded.
Results: A total of 110 patients were included in this study, 103 in the dalbavancin group and 7 in the oritavancin group. The total cost savings were stratified based upon indication for both medications. Overall total cost savings for dalbavancin was $308,788.83 and total cost savings for oritavancin was $54,327.54. Total hospital days saved for dalbavancin were 298 and 26 days for oritavancin. The 90-day hospital readmission rate was 20/103 (19%) in the dalbavancin group and 1/7 (14%) in the oritavancin group. The most common organisms in the dalbavancin group were Methicillin-resistant Staphylococcus aureus (MRSA) with 30/104 (29%) and polymicrobial with 31/103 (30%) and in the oritavancin group was unknown organism with 3/7 (43%). Clinical failure rates for dalbavancin were 14/103 (13%) of patients and oritavancin was 2/7 (28%). 90-day mortality rates for the dalbavancin group were 3/103 (3%) and none in the oritavancin group.
Conclusions: In this study, the clinical utility, cost saving, and decreased length of hospital stays was shown with implementation of dalbavancin and oritavancin. Total cost avoided for both medications during the period was $363,114.37. These results show that the medications will cut costs and facilitate quicker discharge. Further research to showcase the use of long acting lipoglycopeptides at other institutions could reinforce the cost savings potential on a larger scale.
