Describing Antibiotic Utilization Patterns and Healthcare Costs for Ambulatory and Inpatient/ED Treatment of Complicated Urinary Tract Infection (cUTI)
Methods: This was a retrospective analysis of the HealthCore Integrated Research Environment (HIRE) database for the period 2006 through 2013. Patients with cUTI (defined as treatment failure to first AMB ABX administration) were selected and categorized into IPED and ABM groups. The IPED cohort required an initial AMB visit and an ABX prescription for UTI followed by an inpatient/ED admission within 30 days. The AMB cohort was required to have a second office visit and two distinct ABX, on different service dates, within 30 days of initial AMB visit. The index date for the IPED cohort was the cUTI-related admission date and for AMB it was the first cUTI-related physician office visit. AMB patients were followed for 30 days post index date and IPED patients were followed for 30 days pre-index date through the index hospital/ED discharge.
Results: The IPED cohort consisted of 29,533 (41.5%) patients and the AMB cohort consisted of 41,605 (58.5%) patients. Patients were primarily female (IPED: 81%, AMB: 86%) and the average age was similar (IPED =54 and AMB =52) for the two groups. AMB patients had fewer co-morbidities and their Deyo-Charlson Co-morbidity score (mean: 0.8) was lower compared with the IPED cohort (mean: 1.3). During outpatient treatment most patients in both cohorts were treated with an oral antibiotic (AMB = 99.7%; IPED = 96.2%). AMB patients filled an average of 2.6 prescriptions and had 2.1 distinct oral ABX compared to IPED patients who filled 1.4 prescriptions and had 1.3 distinct oral ABX. The AMB cohort also had a greater percentage of IV-ABX use (16.3% vs. 12.3%). All cause mean costs for AMB cohort were $2,871 and $13,612 and $3,720 for the IPED cohort with and without the index hospital/ED admission.
Conclusion: cUTI is a refractory and expensive to treat illness. Long-term antibiotic resistance is a treatment risk. These results provide a basis for future research on improved AMB management strategies that may help prevent or shorten IPED treatment.
AstraZeneca: Employee, Salary
K. Lawrence, None
B. Wu, None
T. Ozgur, None
R. Turner, None