Off-label use of dalbavancin to improve treatment outcomes and reduce health care costs in people who use drugs: A Canadian single-center quality improvement initiative

Background: Dalbavancin is approved in Canada for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). We present a single-center quality improvement case series of dalbavancin use in serious bacterial infections in people who use drugs (PWUD). Our goal was to facilitate access to dalbavancin to improve treatment outcomes and identify potential health system savings. Methods: We established an unrestricted hospital-specific rapid-access compassionate provision program for dalbavancin. Patients were considered for treatment with dalbavancin at the discretion of an infectious diseases physician if they had serious gram-positive infections. Patients provided informed verbal consent. Data were collected via retrospective chart review. We compared costs savings using a practitioner modifiable cost calculator developed by Paladin Labs Inc. Results: Between September 2022 and November 2023, seven patients received dalbavancin. The most common indications for use included early discharge from hospital and improved treatment adherence. Three patients were considered to have infection cure at last follow-up, three patients were presumed to have infection cure but were lost to follow-up, and one patient had infection relapse. Two patients died from causes unrelated to the dalbavancin-treated condition. There were no reported adverse events. Dalbavancin resulted in cost savings compared with standard-of-care (SoC) treatment, and this was primarily driven by reduced inpatient hospital days. Conclusions: Dalbavancin may improve treatment adherence and outcomes for PWUD with serious gram-positive infections while saving health care costs by facilitating earlier discharge from hospital. Our preliminary experience highlights the need for additional controlled studies to evaluate expanded indications for dalbavancin as well as innovative approaches to increase access to novel antimicrobial agents in a single-payer health care system such as Canada.