Impact of Empiric Treatment Failure on Healthcare Resource Utilization and Costs Among Females With Uncomplicated Urinary Tract Infections in a US-Based Integrated Health Delivery Network

OBJECTIVES: Limited data exist on the impact of treatment failure (TF) on healthcare resource utilization (HCRU) and costs for empirically treated uncomplicated urinary tract infections (uUTIs). This retrospective study aimed to describe outcomes and costs in females treated within a US Integrated Delivery Network (IDN).

METHODS: De-identified electronic health record (EHR) data from a world-renowned US IDN were utilized to assess outcomes in females aged ≥12 years between 1/1/2017–1/31/2023. Eligibility criteria included: ≥1 uUTI outpatient diagnosis, ≥1 empiric antibiotic prescription ±5 days of diagnosis (initial prescription date = index date), and ≥12 months of EHR activity both pre‑/post-index. TF definition includes ≥1 of the following ≤28 days post-index: second oral antibiotic prescription, intravenous antibiotic administration, or emergency department (ED) or inpatient stay with UTI listed as the primary diagnosis (index uUTI excluded). HCRU and costs 12‑months post-index were captured by setting of care, for TF and no-TF patients, with medical and pharmacy cost estimates based on the most recent available CMS fee schedule reimbursement rates and prescription costs. Propensity score matching (1-to-1) was utilized to control for imbalances between cohorts.

RESULTS: Of 28,460 patients with uUTI, 4330 (15.2%) experienced TF to empiric therapy. Matched TF and no-TF patients (n=3957 patients/cohort) averaged 53 years old and were predominantly White (>95%). Greater proportions of the TF cohort experienced all-cause inpatient stays (3.1% vs 0.5%; p<0.001) and ED visits (19.1% vs 7.6%; p<0.001) versus the no-TF cohort, during the index uUTI episode. Similarly, the TF cohort exhibited higher mean index uUTI episode all-cause costs ($1369 vs $482; p<0.001) and UTI-related costs ($392 vs $78; p<0.001). All‑cause and UTI-related costs were significantly higher in the TF cohort versus the no-TF cohort across time intervals, during the 12-month post-index period.

CONCLUSIONS: TF after empiric antibiotic treatment in females with uUTI results in significant HCRU and cost burden.