Treatment patterns, healthcare resource use, and costs associated with uncomplicated urinary tract infection among female patients in the United States

Abstract

Background: We evaluated associations between antibiotic prescription and healthcare resource use and costs (Part A), and between antibiotic switching and healthcare resource use, costs, and uncomplicated urinary tract infection recurrence (Part B) in female patients with uncomplicated urinary tract infection in the United States.

Methods: This retrospective cohort study of linked Optum and Premier Healthcare Database data included female patients ≥12 years old with an uncomplicated urinary tract infection diagnosis (index date), who were prescribed antibiotics during an outpatient/emergency department visit between January 1, 2013 and December 31, 2018. In Part A, patients were stratified by antibiotic prescription appropriateness: appropriate and optimal (compliant with Infectious Diseases Society of America 2011 guidelines for drug class/treatment duration) versus inappropriate/suboptimal (inappropriate drug class/treatment duration per Infectious Diseases Society of America 2011 guidelines, and/or treatment failure). In Part B, patients were stratified by treatment pattern (antibiotic switch vs no antibiotic switch). Healthcare resource use and costs during index episode (within 28 days of index date) and 12-month follow-up were compared.

Results: Of 5870 patients (mean age 44.5 years), 2762 (47.1%) had inappropriate/suboptimal prescriptions and 567 (9.7%) switched antibiotic. Inappropriate/suboptimal prescriptions were associated with higher healthcare resource use (mean number of ambulatory care and pharmacy claims [both p < 0.001]), and higher total mean cost (inpatient, outpatient/emergency department, ambulatory visits, and pharmacy costs) per patient ($2616) than appropriate and optimal prescriptions ($649; p < 0.001) (Part A). Antibiotic switching was associated with more pharmacy claims and higher total mean costs (p ≤ 0.01), and a higher incidence of recurrent uncomplicated urinary tract infection (18.9%) than no antibiotic switching (14.2%; p < 0.001) (Part B).

Conclusions: Inappropriate/suboptimal prescriptions and antibiotic switching were associated with high costs, ambulatory care, and pharmacy claims, suggesting a need for improved uncomplicated urinary tract infection prescribing practices in the United States.

Fig 1. Total 12-month UTI-related and all-cause visit costs (adjusted), stratified by appropriateness of antibiotic prescription at index and during follow-up.

Abbreviations: CCI, Charlson Comorbidity Index; CI, confidence interval; ED, emergency department; US, United States; UTI, urinary tract infection. ^aAll cost calculations were adjusted to 2019 US dollars based on Consumer Price Index for all urban consumers for hospital and related services. All models were adjusted for age group (reference: 18–39 years), race/ethnicity (reference: White and non-Hispanic), and CCI (reference: 0 CCI). ^bInpatient and ED visit costs during the index UTI episode were not modeled because, by definition, the appropriate and optimal antibiotic prescription group did not incur any costs. ^cFor total 12-month UTI-related and all-cause visit costs, the models followed inflated zero negative binomial distribution (due to many zero costs in the outcome variable) and used recycled prediction modeling.

Fig 2. Antibiotic switching patterns at index date.

Abbreviations: CIP, ciprofloxacin; NFT, nitrofurantoin; SXT, trimethoprim-sulfamethoxazole.