Complicated urinary tract infections (c-UTI) are expensive and frequently require hospitalization. This study estimated the impact of patient comorbidities, readmissions and treatment delay on the costs of complicated urinary tract infections in both inpatient and outpatient settings. A related aim is to provide the first estimates of the potential savings of treating patients currently treated as inpatients that have clinical characteristics similar to, though less complicated, to patients treated as outpatients. Using one of the largest national claims data sets (30 million lives per year) on privately insured adults and dependents between 2019 and 2022, with regression models we estimate the treatment costs of complicated urinary tract infection (c-UTI) patients identified and treated in the hospital, identified and treated in an outpatient setting and identified in an outpatient setting but subsequently admitted. We statistically estimate potential savings associated with treating inpatient cases in the outpatient setting. Our study was a retrospective analysis of claims data among privately insured adults and dependents with claims from February 1, 2019, to May 31, 2022. Our analysis relies on the Merative- MarketScan Commercial Claims and Encounter database which is among the largest commercially insured set of claims data covering adults and dependents in the U. S. that included de-identified person-level claims data including inpatient, outpatient, and prescription drugs use and spending. It also included health plan spending, patient demographics, diagnosis, procedure and national drug codes covering more than 30 million active employees, early retirees, COBRA extenders, and dependents with data contributed by more than 160 employers and 40 health plans nationally each year. Data were obtained for 93, 228 c-UTI patients treated in both inpatient and outpatient settings in the United States. Treatment costs are highly positively skewed with a mean cost per episode of those identified in hospital of 42, 000 and median cost of 27, 784. High costs were in part linked to long lengths of stay for roughly 10% of patients of 15 days or longer. At the other extreme we found that many low-acuity patients were hospitalized. Switching antibiotics also increased treatment costs. The results show that 27% of c-UTI patients admitted to the hospital were low-acuity patients that potentially could be treated in an outpatient setting for over 31, 000 per case less. The results highlight several areas of opportunity to reduce dramatically the costs of treating c-UTI including treating currently hospitalized low-acuity patients without complications in an outpatient setting, reducing readmissions, and length of stay. This is the first national study of the total episode-based costs of treating privately insured c-UTI patients in the United States. The study relies on among the largest commercially available data sets in the United States that include over 30 million individuals. The study provides the first estimate showing the financial savings potentially associated with treating low acuity patients with no comorbid conditions or sepsis as outpatients rather than inpatients. We developed a novel counterfactual set of regression models to predict treatment costs for inpatient c-UTI patients assuming they were treated as outpatients. The analysis did not include those with Medicare, Medicaid, the uninsured or other non-commercially insured patients.
Thorpe et al. (Fri,) studied this question.