1691 - Pre- and Post-Hospitalization Resource Utilization and Costs Associated with Urinary Tract Infection (UTI) in both Commercial and Medicare Populations

Background: In the United States, urinary tract infections (UTIs) result in an estimated 7 million office visits, 1 million emergency department visits, and over 500,000 hospitalizations with an associated annual cost of $1.6 billion. Little is known regarding pre- and post-hospitalization resource use. Here, we quantify resource utilization and costs associated with both commercially insured and Medicare patients hospitalized for UTI.

Methods: A retrospective multi-center study using data from the MarketScan® Commercial and Medicare Supplemental Databases was performed. Inclusion criteria: (1) inpatient hospital admission with a primary ICD-10 diagnosis for UTI between October 1, 2015 and December 31, 2017 (index hospitalization), (2) at least 6 months of continuous enrollment and pharmacy benefits prior to the index date, (3) at least 12 months of continuous enrollment and pharmacy benefits after the index date, (4) patient age < 64 (Commercial) or ≥65 (Medicare) on the index date. Demographics, hospitalization characteristics, antibiotic use, and resource utilization/costs in the pre- and post-index periods were examined.

Results: 5,248 Commercial and 7,791 Medicare patients were eligible for analysis. 29.7% and 24.1% of Medicare and Commercial patients, respectively, were male.  5.9% of Medicare patients had a claim for skilled nursing facilities (SNF) in the 14 days pre-index admission (1.0% Commercial), 9.1% had emergency department claims (13.1% Commercial), and 39.8% had office visit claims (49.9% Commercial). Post-hospitalization, 20.3% (1.3% Commercial) were discharged to SNF and 15.4% (4.7%) were discharged to home health services. Mean insurer UTI-related costs were $8,677 (Commercial) and $5,358 (Medicare) in the 6 months pre-index hospitalization. Similarly, costs were $21,135 (Commercial) and $22,342 (Medicare) in the 12 months post hospitalization ($3,944 and $2,988 in the first 30 days post-discharge, respectively).

Conclusion: UTI is associated with substantial costs and resource utilization to insurers in both pre- and post-hospitalization settings. Understanding total costs of care and location of service may aid in cost-reduction strategies for treating UTI.