Turner Ralph M, Wu Bingcao, Lawrence Kenneth, Hackett Judith, Karve Sudeep, Tunceli Ozgur
HealthCore, Inc, Wilmington, Delaware.
HealthCore, Inc, Wilmington, Delaware.
Clin Ther. 2015 Sep;37(9):2037-47. doi: 10.1016/j.clinthera.2015.06.013. Epub 2015 Jul 23.
The goal of this study was to examine treatment patterns, utilization, and costs for complicated urinary tract infections (UTIs) requiring inpatient/emergency department (ED) and outpatient care.
This observational study evaluated inpatient/ED-treated and outpatient-treated patients (aged ≥18 years) with complicated UTIs from 2 large US administrative claims databases (HealthCore Integrated Research Environment and Premier Perspective Database). Patient identification depended on treatment setting: outpatients had 2 UTI diagnosis-related office visits and 2 claims for different antibiotics within 30 days, and inpatients had a UTI-related hospitalization/ED visit after 1 UTI diagnosis-related office visit plus 2 claims for different antibiotics within 30 days. The index date for outpatients was the date of the first office visit; for inpatients, it was the date of admission/ED visit. Both cohorts had continuous insurance eligibility. Outcomes were assessed by using univariate and multivariate statistics.
The study sample included 1118 inpatient/ED patients (76.6% female subjects; mean age, 62.4 years) and 41,605 outpatients (85.8% female subjects; mean age, 52.3 years). Mean (SD) pharmacy costs were $2971 ($7650) for inpatient/ED patients and $1882 ($3120) for outpatients during the full treatment period. Index hospitalization/ED averaged $38,422 ($51,161). Mean all-cause 90-day follow-up costs for the inpatient/ED cohort were $34,100 ($71,621) and $11,345 ($34,313) for the outpatient cohort.
Relative to outpatient-treated patients, inpatient/ED-treated patients were older, sicker, had higher costs across treatment periods, and had reduced antibiotic use at a lower rate during the 90-day follow-up. Strategies to avoid preventable inpatient/ED visits may help reduce costs in the management of outpatients with complicated UTIs.
本研究的目的是研究需要住院/急诊科（ED）和门诊治疗的复杂性尿路感染（UTI）的治疗模式、利用率和成本。
这项观察性研究评估了来自美国2个大型行政索赔数据库（HealthCore综合研究环境和Premier透视数据库）中年龄≥18岁的复杂性UTI住院/ED治疗患者和门诊治疗患者。患者识别取决于治疗环境：门诊患者在30天内有2次与UTI诊断相关的门诊就诊和2次不同抗生素的索赔，住院患者在1次与UTI诊断相关的门诊就诊加30天内2次不同抗生素的索赔后有1次与UTI相关的住院/ED就诊。门诊患者的索引日期是第一次门诊就诊日期；住院患者是入院/ED就诊日期。两个队列都有连续的保险资格。通过单变量和多变量统计评估结果。
研究样本包括1118名住院/ED患者（76.6%为女性；平均年龄62.4岁）和41605名门诊患者（85.8%为女性；平均年龄52.3岁）。在整个治疗期间，住院/ED患者的平均（标准差）药房成本为2971美元（7650美元），门诊患者为1882美元（3120美元）。索引住院/ED平均为38422美元（51161美元）。住院/ED队列的平均全因90天随访成本为34100美元（71621美元），门诊队列为11345美元（34313美元）。
与门诊治疗患者相比，住院/ED治疗患者年龄更大、病情更重，在整个治疗期间成本更高，并且在90天随访期间抗生素使用率下降率更低。避免可预防的住院/ED就诊的策略可能有助于降低复杂性UTI门诊患者管理中的成本。
