Wilke Thomas, Böttger Björn, Berg Björn, Groth Antje, Botteman Marc, Yu Shengsheng, Fuchs Andreas, Maywald Ulf
IPAM - Institut fx00FC;r Pharmakox00F6;konomie und Arzneimittellogistik, University of Wismar, Wismar, Germany.
Nephron. 2016;132(3):215-26. doi: 10.1159/000444420. Epub 2016 Mar 2.
We examined the real-world treatment of urinary tract infections (UTIs) in a type 2 diabetes mellitus (T2DM) population, evaluated UTI-related healthcare resource use and direct treatment costs, and assessed factors that may predict UTI-related costs.
We analyzed an anonymized dataset from a regional German healthcare fund (2010-2012). UTI-associated resource use was described by the number of UTI-associated outpatient visits, the number and length of UTI-related acute hospital visits, and the number of UTI-related antibiotics prescriptions. UTI-related direct treatment costs were studied both based on these resource use numbers and, additionally, based on a comparison of all-cause annual healthcare costs of T2DM-patients who were or were not affected by a UTI. To identify factors that might predict direct treatment costs related to UTI treatment, we conducted generalized linear regression model analyses (based on gamma distribution) using sociodemographic and clinical characteristics of observed patients as available in the database as independent variables.
A total of 456,586 T2DM-patients were included with a mean age of 73.8, a percentage of 56.3 female patients, and a mean Charlson comorbidity index of 7.3. In our database, we observed 48,337 UTI events. The direct mean resource-based costs were €315.90 per UTI event. Older age, higher comorbidity status, at least one previous non-UTI infection, and poorer renal function were associated with higher costs, while female gender and at least one previous UTI event were associated with lower costs. In the all-cause cost analysis, healthcare costs per patient year were €3,916 higher in the UTI group than in the non-UTI group.
Our study confirms that UTI is a common complication in patients with T2DM. Patients with T2DM who have had previous infections, who are older, and who are male, as well as patients who have more comorbidities or severe renal insufficiency, face above-average UTI treatment costs. These patient groups, therefore, should receive special attention in the real-world treatment of T2DM, which should include a regular screening of UTI risk.
我们研究了2型糖尿病（T2DM）人群中尿路感染（UTI）的实际治疗情况，评估了与UTI相关的医疗资源使用和直接治疗成本，并评估了可能预测UTI相关成本的因素。
我们分析了来自德国一个地区医疗基金的匿名数据集（2010 - 2012年）。UTI相关的资源使用情况通过UTI相关门诊就诊次数、UTI相关急性住院就诊次数和时长以及UTI相关抗生素处方数量来描述。UTI相关的直接治疗成本既基于这些资源使用数量进行研究，此外，还基于对受UTI影响或未受UTI影响的T2DM患者全因年度医疗成本的比较进行研究。为了确定可能预测UTI治疗直接成本的因素，我们使用数据库中观察到的患者的社会人口统计学和临床特征作为自变量，进行广义线性回归模型分析（基于伽马分布）。
共纳入456,586例T2DM患者，平均年龄73.8岁，女性患者占比56.3%，平均Charlson合并症指数为7.3。在我们的数据库中，观察到48,337例UTI事件。基于资源的直接平均成本为每次UTI事件315.90欧元。年龄较大、合并症状态较高、至少有一次既往非UTI感染以及肾功能较差与较高成本相关，而女性性别和至少有一次既往UTI事件与较低成本相关。在全因成本分析中，UTI组患者每年的医疗成本比非UTI组高3916欧元。
我们的研究证实UTI是T2DM患者常见的并发症。既往有感染、年龄较大、男性以及合并症较多或有严重肾功能不全的T2DM患者面临高于平均水平的UTI治疗成本。因此，在T2DM的实际治疗中，这些患者群体应受到特别关注，其中应包括对UTI风险的定期筛查。
