POST-DISCHARGE TREATMENT PATHWAYS AFTER IV THERAPY FOR COMPLICATED UTI INCLUDING ACUTE PYELONEPHRITIS: IMPLICATIONS FOR LENGTH OF STAY, COSTS, AND TREATMENT FAILURE
Author(s)
Amy G Edgecomb, PharmD, MPH1, thomas lodise, PharmD, PhD2, Aaron Lucas, MD3, Fanny S. Mitrani-Gold, MPH1, Lindsey Parker, PharmD1, Benjamin Chastek, MS4, Jillian E. Hayes, PharmD, BCIDP1, Timothy Barnes, PhD, MPH, MHI, MBA4, Kruti Joshi, MPH5.
1GSK, Collegeville, PA, USA, 2Albany College of Pharmacy and Health Sciences, Stratton, VA, USA, 3Pittsburgh VA Medical Center, Pittsburgh, PA, USA, 4Optum, Eden Prairie, MN, USA, 5GlaxoSmithKline, Collegeville, PA, USA.
1GSK, Collegeville, PA, USA, 2Albany College of Pharmacy and Health Sciences, Stratton, VA, USA, 3Pittsburgh VA Medical Center, Pittsburgh, PA, USA, 4Optum, Eden Prairie, MN, USA, 5GlaxoSmithKline, Collegeville, PA, USA.
OBJECTIVES: This study evaluated length of stay (LOS), healthcare resource utilization (HCRU), costs, and treatment failure (TF) among adults hospitalized with complicated urinary tract infections (cUTI) including acute pyelonephritis (AP), who completed IV antibiotics in the hospital (IV-complete), or were discharged via IV-to-oral antibiotics (IV-to-PO) or IV-to-outpatient parenteral antibiotic therapy (IV-to-OPAT) in the 4-days post-discharge.
METHODS: Retrospective cohort study using Optum Market Clarity database (10/01/2015-09/30/2023). Included hospitalized adults with cUTI/AP, who were treated with IV antibiotics and received a urine culture-sensitivity report +/-2 days of admission (index). Outcomes: LOS and costs during index; HCRU and costs during 30-days post-discharge; and TF within 5-30 days post-discharge (UTI-related inpatient or emergency department (ER) visit, new IV antibiotic prescription, or death). Subgroups: patients with IV carbapenem (IVC), and ESBL-positive and fluoroquinolone-not-susceptible or trimethoprim/sulfamethoxazole-resistant pathogens (MDR2). Multivariable models evaluated LOS.
RESULTS: Among 54,216 patients, 58% were IV-to-PO, 10% IV-to-OPAT, and 33% IV complete; 11% MDR2 and 13% IVC. LOS and hospital costs (overall/MDR2/IVC) median (IQR) were IV-to-PO: 5(4-6)/5(4-7)/6(4-9) days and $20K($12K-32K)/$20K($11K-33K)/$26K($16K-42K); IV-to-OPAT: 2(1-6)/3(1-6)/6(4-8) and $17K($4K-34K)/$19K($3K-34K)/$25K($13K-41K); IV-complete: 8(6-13)/8(6-12)/10(7-16) and $33K($17K-63K)/$32K($16K-60K)/$40K($21K-84K). Compared with IV-to-PO, adjusted analyses showed earlier time to discharge among IV-to-OPAT (HR 1.189 [95%CI: 1.154-1.224], p<0.001) and delayed time to discharge among IV-complete (0.412 [0.404-0.420]; p<0.001). TF occurred in (overall/MDR2/IVC) IV-to-PO: 32%/37%/37%; IV-to-OPAT: 25%/26%/26%; IV-complete: 29%/35%/37%. Overall, all-cause 30-days post-discharge costs (median [IQR]) and HCRU (ER/inpatient/outpatient visits,%) were IV-to-PO: $3K($760-12K) and 22%/21%/35%; IV-to-OPAT: $9K($3K-24K) and 38%/34%/45%; IV-complete: $6K($1K-20K) and 27%/38%/29%.
CONCLUSIONS: Compared with IV-to-PO, IV-to-OPAT patients experienced earlier discharge, but higher post-discharge costs, ER, inpatient, and outpatient visits. IV-complete patients had delayed discharge, and the highest index hospitalization costs. IV-to-PO patients had higher post-discharge TF, particularly in MDR2, which was largely driven by subsequent IV antibiotic use. These findings highlight the value of effective oral step-down options to support timely discharge and reduce HCRU.
METHODS: Retrospective cohort study using Optum Market Clarity database (10/01/2015-09/30/2023). Included hospitalized adults with cUTI/AP, who were treated with IV antibiotics and received a urine culture-sensitivity report +/-2 days of admission (index). Outcomes: LOS and costs during index; HCRU and costs during 30-days post-discharge; and TF within 5-30 days post-discharge (UTI-related inpatient or emergency department (ER) visit, new IV antibiotic prescription, or death). Subgroups: patients with IV carbapenem (IVC), and ESBL-positive and fluoroquinolone-not-susceptible or trimethoprim/sulfamethoxazole-resistant pathogens (MDR2). Multivariable models evaluated LOS.
RESULTS: Among 54,216 patients, 58% were IV-to-PO, 10% IV-to-OPAT, and 33% IV complete; 11% MDR2 and 13% IVC. LOS and hospital costs (overall/MDR2/IVC) median (IQR) were IV-to-PO: 5(4-6)/5(4-7)/6(4-9) days and $20K($12K-32K)/$20K($11K-33K)/$26K($16K-42K); IV-to-OPAT: 2(1-6)/3(1-6)/6(4-8) and $17K($4K-34K)/$19K($3K-34K)/$25K($13K-41K); IV-complete: 8(6-13)/8(6-12)/10(7-16) and $33K($17K-63K)/$32K($16K-60K)/$40K($21K-84K). Compared with IV-to-PO, adjusted analyses showed earlier time to discharge among IV-to-OPAT (HR 1.189 [95%CI: 1.154-1.224], p<0.001) and delayed time to discharge among IV-complete (0.412 [0.404-0.420]; p<0.001). TF occurred in (overall/MDR2/IVC) IV-to-PO: 32%/37%/37%; IV-to-OPAT: 25%/26%/26%; IV-complete: 29%/35%/37%. Overall, all-cause 30-days post-discharge costs (median [IQR]) and HCRU (ER/inpatient/outpatient visits,%) were IV-to-PO: $3K($760-12K) and 22%/21%/35%; IV-to-OPAT: $9K($3K-24K) and 38%/34%/45%; IV-complete: $6K($1K-20K) and 27%/38%/29%.
CONCLUSIONS: Compared with IV-to-PO, IV-to-OPAT patients experienced earlier discharge, but higher post-discharge costs, ER, inpatient, and outpatient visits. IV-complete patients had delayed discharge, and the highest index hospitalization costs. IV-to-PO patients had higher post-discharge TF, particularly in MDR2, which was largely driven by subsequent IV antibiotic use. These findings highlight the value of effective oral step-down options to support timely discharge and reduce HCRU.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE440
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Infectious Disease (non-vaccine), SDC: Urinary/Kidney Disorders