Presentation (CTI)

OBJECTIVES: To perform the cost of illness analysis for urinary tract infections (UTIs) caused by resistant Escherichia coli (E. coli) from a societal perspective.
METHODS: A macrocosting approach was used to calculate outpatient and inpatient costs from payer, patient, and societal perspectives over a 1-year time horizon. The human capital approach was employed to calculate indirect costs due to sick leave. Information about the frequency of resistance, prices of medicines, hospitalisation duration, and standards of therapy in case of resistance was taken from officially published national databases and guidelines.
RESULTS: Outpatient treatment with fluoroquinolones costs on average €26.33 per patient, amoxicillin/clavulanic acid costs €15.99, while cephalexin therapy costs €3.62. The cost for consultations and tests is €40. Inpatient therapy costs vary: €38 for initial treatment with third- or fourth-generation cephalosporins, €117 when switching to piperacillin-tazobactam therapy, and €72 for treatment with fluoroquinolones. The total cost of a complete inpatient course of treatment is €593. Additionally, treatment failure due to antibiotic resistance can lead to extra costs of at least €20 from the patient's perspective and €190 from the perspective of the health insurance fund for each patient. Indirect costs due to inpatient treatment are three times higher than direct costs.
CONCLUSIONS: UTIs caused by resistant E. coli are associated with significant healthcare payers and societal costs. Inpatient costs are more than three times higher than outpatient costs. There is a need for strengthening antimicrobial stewardship, ensuring access to first-line antimicrobials that are currently unavailable (e.g., nitrofurantoin, pivmecillinam), improving surveillance of antibiotic utilisation and resistance, and targeted policy measures in Bulgaria.