Complicated UTIs—A Common and Costly Problem: Public Health Watch

October 30, 2019

Open Forum Infectious Diseases research highlights incidence and cost burden associated with common infection.

Complicated urinary tract infections (cUTIs) are an expensive proposition—which is particularly frightening given how common they are.

Research suggests cUTIs affect more than 100 million people globally per year. In the United States, some 70%—80% have been linked with the use of indwelling catheters, accounting for 1 million cases annually alone.

Now, thanks to a new analysis published on October 21st in Open Forum Infectious Diseases, we have a better sense of how much it costs to treat these pesky bugs, which requires hospitalization in as many as 30% of cases. And, perhaps not surprisingly, the expense equation is likely exacerbated by infections caused by antimicrobial-resistant bacteria.

“I believe that the ongoing antimicrobial resistance crisis has increased the costs and reduced the efficacy of our current treatments for cUTI,” study co-author Joseph J. Carreno, PharmD, an infectious disease pharmacist and associate professor, Albany College of Pharmacy and Health Sciences told Contagion®. “In this study, we did not have individual culture data, so we were unable to assess the impact of antimicrobial resistance directly. However, we know that many of the patients treated in the outpatient setting received fluoroquinolones and trimethoprim-sulfamethoxazole. Previous studies of outpatient urinary isolates have demonstrated high rates of resistance to these antibiotics. The combination of these 2 observations provides strong evidence that antimicrobial resistance may have impacted the study outcomes.”

“ID specialists and pharmacists [should work] together with local and state officials to create coordinated approaches to outpatient antimicrobial stewardship [in the management of cUTI],” he continued.

Carreno and his colleagues performed a retrospective study of the PharmMetrics Plus database, covering a 4-year period from 2013 through 2017. They assessed data of more than 500,000 adults with confirmed cUTI diagnosis, sorting study participants into 2 “mutually exclusive study cohorts”—those diagnosed in inpatient (IP; n=104,866) and outpatient (OP; n=438,636) settings, respectively.

Their analysis revealed an overall incidence of cUTI of 1.01%, which would translate to nearly 2.9 million cases annually the United States. In the IP cohort, overall median 30-day health care costs exceeded $13,000, with median costs for the initial hospital admission at $9441 and median length of stay of 4 days. Among those diagnosed in an IP setting, 12.3% had a subsequent hospital readmission.

Meanwhile, within the OP cohort, median 30-day health care costs were just over $1500, with 9.2% requiring a 30-day admission.

Overall, the authors described the projected economic burden associated with cUTIs as “substantial.” Based on their analysis, they estimated that the total median 30-day health care costs associated with each cUTI case was approximately $2000 US dollars, which based on their incidence projections would result in total annualized in excess of $6 billion for the US health care system.

“Given the commonality of cUTI in our clinical practices, the observed prevalence was not completely surprising,” Carreno noted. “To me, the more striking aspect of the data was the economic burden, especially the outpatient data. When we first looked at the cost of outpatient treatment it wasn’t immediately clear why the median cost exceeded $1500 per patient. However, when we drilled down on the data we noted that recurrence was common and patients often required multiple outpatient antibiotic treatments. These additional treatments, emergency department visits, and subsequent hospital admissions likely drove up costs.”

And created a significant expense for patients—and health care systems—alike.