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Observational Study
. 2018 Apr 12;8(4):e020251.
doi: 10.1136/bmjopen-2017-020251.

Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study

Laura Vallejo-Torres  1   2 , Miquel Pujol  3   4 , Evelyn Shaw  3   4 , Irith Wiegand  5 , Joan Miquel Vigo  6 , Margaret Stoddart  7 , Sally Grier  7 , Julie Gibbs  7 , Christiane Vank  5 , Nienke Cuperus  8 , Leo van den Heuvel  8 , Noa Eliakim-Raz  9   10 , Jordi Carratala  3   4 , Cuong Vuong  5 , Alasdair MacGowan  7 , Tanya Babich  9   10 , Leonard Leibovici  9   10 , Ibironke Addy  5 , Stephen Morris  1 ; RESCUING Study Group and Study Sites
Collaborators, Affiliations
Observational Study

Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study

Laura Vallejo-Torres et al. BMJ Open. .

Abstract

Objective: Complicated urinary tract infections (cUTIs) impose a high burden on healthcare systems and are a frequent cause of hospitalisation. The aims of this paper are to estimate the cost per episode of patients hospitalised due to cUTI and to explore the factors associated with cUTI-related healthcare costs in eight countries with high prevalence of multidrug resistance (MDR).

Design: This is a multinational observational, retrospective study. The mean cost per episode was computed by multiplying the volume of healthcare use for each patient by the unit cost of each item of care and summing across all components. Costs were measured from the hospital perspective. Patient-level regression analyses were used to identify the factors explaining variation in cUTI-related costs.

Setting: The study was conducted in 20 hospitals in eight countries with high prevalence of multidrug resistant Gram-negative bacteria (Bulgaria, Greece, Hungary, Israel, Italy, Romania, Spain and Turkey).

Participants: Data were obtained from 644 episodes of patients hospitalised due to cUTI.

Results: The mean cost per case was €5700, with considerable variation between countries (largest value €7740 in Turkey; lowest value €4028 in Israel), mainly due to differences in length of hospital stay. Factors associated with higher costs per patient were: type of admission, infection source, infection severity, the Charlson comorbidity index and presence of MDR.

Conclusions: The mean cost per hospitalised case of cUTI was substantial and varied significantly between countries. A better knowledge of the reasons for variations in length of stays could facilitate a better standardised quality of care for patients with cUTI and allow a more efficient allocation of healthcare resources. Urgent admissions, infections due to an indwelling urinary catheterisation, resulting in septic shock or severe sepsis, in patients with comorbidities and presenting MDR were related to a higher cost.

Keywords: cost of illness; health economics; urinary tract infections.

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Conflict of interest statement

Competing interests: Within the IMI project, AiCuris provided support for the institutions of the following Researchers: LVT, MP, ES, JMV, MS, SG, JG, NC, LH, NE-R, JC, AM, TB, LL and SM. IW, ChV, CuV and IA are employees of AiCuris Anti-infective Cures GmbH, an EFPIA (European Federation of Pharmaceutical Industries and Association) member in the IMI JU. Costs related to the research contribution by IW, ChV, CuV and IA are borne by AiCuris Anti-infective Cures GmbH and considered in-kind contribution under the IMI JU scheme.

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