Healthcare Resource Use and Costs Associated with Oral Antibiotic Treatment Failure in Uncomplicated Urinary Tract Infection in the US

OBJECTIVES: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide. Despite many antibiotics being available for the treatment of uncomplicated UTI (uUTI), many patients still experience treatment failure. This study assessed the burden of oral antibiotic treatment failure in women with uUTI.

METHODS: This retrospective cohort study used data from the OPTUM claims dataset between October 1, 2015, and September 30, 2021. Female patients aged ≥18 years with a uUTI diagnosis, an oral antibiotic prescription ±5 days of diagnosis (index date), and ≥1 year of continuous health plan enrollment pre- and post-index date were included. Patients were stratified into subgroups based on evidence of uUTI antibiotic treatment failure, defined as receiving a second oral antibiotic prescription, intravenous antibiotics, or a second primary diagnosis of UTI in an acute care setting (emergency room or inpatient) within 28 days of index date (index episode). Healthcare resource use and costs were assessed for the index uUTI.

RESULTS: In total, 238,335 patients were identified, of which 29,333 (12.31%) had evidence of treatment failure. For patients with treatment failure versus those without treatment failure, respectively, the number of uUTI-related emergency department visits (0.11 vs. 0.04), office visits (1.01 vs. 0.68), lab/radiology tests (4.07 vs. 2.23), and prescription claims (2.20 vs. 1.05) were significantly higher (all p<0.001). Outpatient costs (uUTI-related) for the index episode per patient were significantly higher for patients with treatment failure versus those without treatment failure (US$698 vs. US$185; p<0.001).

CONCLUSIONS: In total, 12.31% of patients experienced treatment failure. Patients who experienced antibiotic treatment failure for uUTI had significantly higher healthcare resource use and costs compared with patients without evidence of treatment failure, demonstrating a need for more guideline-adherent, optimized antibiotic treatment of uUTI.