title: Assessment of Outpatient and Inpatient Antibiotic Treatment Patterns and Health Care Costs of Patients with Complicated Urinary Tract Infections.
abstract: OBJECTIVE
  The goal of this study was to examine treatment patterns, utilization, and costs for complicated urinary tract infections (UTIs) requiring inpatient/emergency department (ED) and outpatient care.
  
  
  METHODS
  This observational study evaluated inpatient/ED-treated and outpatient-treated patients (aged ≥18 years) with complicated UTIs from 2 large US administrative claims databases (HealthCore Integrated Research Environment and Premier Perspective Database). Patient identification depended on treatment setting: outpatients had 2 UTI diagnosis-related office visits and 2 claims for different antibiotics within 30 days, and inpatients had a UTI-related hospitalization/ED visit after 1 UTI diagnosis-related office visit plus 2 claims for different antibiotics within 30 days. The index date for outpatients was the date of the first office visit; for inpatients, it was the date of admission/ED visit. Both cohorts had continuous insurance eligibility. Outcomes were assessed by using univariate and multivariate statistics.
  
  
  RESULTS
  The study sample included 1118 inpatient/ED patients (76.6% female subjects; mean age, 62.4 years) and 41,605 outpatients (85.8% female subjects; mean age, 52.3 years). Mean (SD) pharmacy costs were $2971 ($7650) for inpatient/ED patients and $1882 ($3120) for outpatients during the full treatment period. Index hospitalization/ED averaged $38,422 ($51,161). Mean all-cause 90-day follow-up costs for the inpatient/ED cohort were $34,100 ($71,621) and $11,345 ($34,313) for the outpatient cohort.
  
  
  CONCLUSIONS
  Relative to outpatient-treated patients, inpatient/ED-treated patients were older, sicker, had higher costs across treatment periods, and had reduced antibiotic use at a lower rate during the 90-day follow-up. Strategies to avoid preventable inpatient/ED visits may help reduce costs in the management of outpatients with complicated UTIs.
authors.affiliation: HealthCore, Inc, Wilmington, Delaware. Electronic address: rturner@healthcore.com.
authors.forename: Ralph M
authors.initials: RM
authors.lastname: Turner
authors.affiliation: HealthCore, Inc, Wilmington, Delaware.
authors.forename: Bingcao
authors.initials: B
authors.lastname: Wu
authors.affiliation: AstraZeneca R&D, Waltham, Massachusetts.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lawrence
authors.affiliation: AstraZeneca R&D, Waltham, Massachusetts.
authors.forename: Judith
authors.initials: J
authors.lastname: Hackett
authors.affiliation: AstraZeneca R&D, Waltham, Massachusetts.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Karve
authors.affiliation: HealthCore, Inc, Wilmington, Delaware.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tunceli
mesh_terms: D000067575:Administrative Claims, Healthcare; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; antimicrobials; complicated urinary tract infections; uncomplicated urinary tract infections; urinary tract infection