Comparing the Cost of Administering and Monitoring Vancomycin and Daptomycin Through a Home Infusion Pharmacy

Introduction This study evaluates the cost differences between administering and monitoring vancomycin and daptomycin in a home infusion pharmacy (HIP) setting. Both antibiotics are widely used for treating methicillin-resistant Staphylococcus aureus (MRSA) and other gram-positive infections in outpatient parenteral antibiotic therapy (OPAT), but vancomycin requires more intensive therapeutic monitoring than daptomycin. The study aims to quantify pharmacist time spent monitoring patients, lab costs, and overall drug administration costs associated with each therapy in a HIP serving 16 medical centers in Northern California. Methods Using a retrospective chart review of 113 patients who received either vancomycin or daptomycin between August and December 2022, the study compares pharmacist time spent, drug and administration device costs, and laboratory costs for each therapy. Results Results show that while pharmacist time spent per note was similar for both antibiotics, vancomycin patients required significantly more notes per therapy day, resulting in higher monitoring costs. The average daily pharmacist time and associated costs for vancomycin were significantly higher than for daptomycin ($37.99 vs. $22.60 per day). Additionally, vancomycin required more frequent and expensive lab tests, leading to higher laboratory costs ($14.01 vs. $5.24 per day). Discussion The overall cost per therapy day for vancomycin was significantly higher than for daptomycin ($84.56 vs. $59.75), largely due to increased pharmacist time and lab costs, despite the similar cost of drug and administration devices. The study highlights the potential cost savings of using daptomycin over vancomycin in a home infusion setting, particularly for uncomplicated infections. However, limitations include the exclusion of complex clinical scenarios and the potential variation in costs across different health care systems. Conclusions These findings suggest that daptomycin may be a more cost-effective alternative to vancomycin for home-based therapy, prompting further evaluation of clinical practices and resource allocation in HIP services.