The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community

Abstract

Introduction: Scant data are available on the 30-day financial burden associated with incident complicated urinary tract infections (cUTIs) in a cohort of predominately elderly patients. This study sought to examine total and cUTI-related 30-day Medicare spending (MS), a proxy for healthcare costs, among Medicare fee-for-service (FFS) beneficiaries who resided in the community with newly diagnosed cUTIs. Methods: A retrospective multicenter cohort study of adult beneficiaries in the Medicare FFS database with a cUTI between 2017 and 2018 was performed. Patients were included if they were enrolled in Medicare FFS and Medicare Part D from 2016 to 2019, had a cUTI first diagnosis in 2017–2018, no evidence of any UTI diagnoses in 2016, and residence in the community between 2016 and 2018. Results: During the study period, 723,324 cases occurred in Medicare beneficiaries who met the study criteria. Overall and cUTI-related 30-day MS were $7.6 and $4.5 billion, respectively. The average overall and cUTI-related 30-day MS per beneficiary were $10,527 and $6181, respectively. The major driver of cUTI-related 30-day MS was acute care hospitalizations ($3.2 billion) and the average overall and cUTI-related 30-day MS per hospitalizations were $16,431 and $15,438, respectively. Conclusion: Overall 30-day MS for Medicare FSS patients who resided in the community with incident cUTIs was substantial, with cUTI-related MS accounting for 59%. As the major driver of cUTI-related 30-day MS was acute care hospitalizations, healthcare systems should develop well-defined criteria for hospital admissions that aim to avert hospitalizations in clinically stable patients and expedite the transition of patients to the outpatient setting to complete their care.

A Cost Savings Analysis of Topical Estrogen Therapy in Urinary Tract Infection Prevention Among Postmenopausal Women

“…By virtue of decreasing the number of UTIs, topical estrogen may decrease the antibiotic load faced by patients, thereby decreasing the cost of more expensive antibiotics needed for resistant infections. We weighted and averaged costs based on the published proportions of complicated and resistant infections, 7,[20][21][22] which may, however, underrepresent cost of UTI as patients with recurrent infections are more likely to have resistant infections and are more likely to have higher out-of-pocket and indirect health care costs than patients initially diagnosed with UTI. 39,42,43 While we understand that dosing may have an impact on the efficacy of estrogen therapy, it is unclear which route of administration is most efficacious as no randomized control study has definitively proven superiority of a cream vs a ring form of therapy.…”

“…22 Based on prior studies, 98.3% of women were expected to have uncomplicated infection with the previously established cost of $1030, 22 while 1.7% of women were expected to have a complicated infection with a cost of $6181. 21,22 An additional 1.7% of the population would go on to transition to a complicated infection after initiating treatment for their uncomplicated infection. 23 These results are congruent with a published 3% complicated infection rate.…”

“…18,19 Previous studies of Medicare claims data have shown the significant economic burden of UTI. [20][21][22] Our study sought to assess the cost of recurrent UTI in the postmenopausal patient and the impact of topical estrogen therapies by systematic literature review. Given the reduction in annual UTI episodes reported utilizing topical estrogen therapy, we sought to evaluate the potential cost savings with widespread use for UTI prevention in postmenopausal patients with recurrent infections.…”

New Insights in Molecular Mechanisms in Antimicrobial Resistance and Strategies in Anti-Biofilms

“…It was concluded that the NDM is the main resistance mechanism against carbapenems and is dominant in this region. The last manuscript in this sub-topic, entitled “The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community”, describes a retrospective multicenter cohort study of adult beneficiaries in the Medicare fee-for-service (FFS) database with complicated urinary tract infections (cUTI) between 2017 and 2018 [ 4 ]. A total of 723,324 cases reported in Medicare beneficiaries who met the study criteria were included and the major driver of cUTI-related 30-day MS was concluded as acute care hospitalizations.…”