Healthcare Burden and Costs Associated with Urinary Tract Infections in Type 2 Diabetes Mellitus Patients: An Analysis Based on a Large Sample of 456,586 German Patients

Abstract

Objectives: We examined the real-world treatment of urinary tract infections (UTIs) in a type 2 diabetes mellitus (T2DM) population, evaluated UTI-related healthcare resource use and direct treatment costs, and assessed factors that may predict UTI-related costs. Methods: We analyzed an anonymized dataset from a regional German healthcare fund (2010-2012). UTI-associated resource use was described by the number of UTI-associated outpatient visits, the number and length of UTI-related acute hospital visits, and the number of UTI-related antibiotics prescriptions. UTI-related direct treatment costs were studied both based on these resource use numbers and, additionally, based on a comparison of all-cause annual healthcare costs of T2DM-patients who were or were not affected by a UTI. To identify factors that might predict direct treatment costs related to UTI treatment, we conducted generalized linear regression model analyses (based on gamma distribution) using sociodemographic and clinical characteristics of observed patients as available in the database as independent variables. Results: A total of 456,586 T2DM-patients were included with a mean age of 73.8, a percentage of 56.3 female patients, and a mean Charlson comorbidity index of 7.3. In our database, we observed 48,337 UTI events. The direct mean resource-based costs were €315.90 per UTI event. Older age, higher comorbidity status, at least one previous non-UTI infection, and poorer renal function were associated with higher costs, while female gender and at least one previous UTI event were associated with lower costs. In the all-cause cost analysis, healthcare costs per patient year were €3,916 higher in the UTI group than in the non-UTI group. Conclusion: Our study confirms that UTI is a common complication in patients with T2DM. Patients with T2DM who have had previous infections, who are older, and who are male, as well as patients who have more comorbidities or severe renal insufficiency, face above-average UTI treatment costs. These patient groups, therefore, should receive special attention in the real-world treatment of T2DM, which should include a regular screening of UTI risk.

A new concept and a comprehensive evaluation of SYSMEX UF-1000i flow cytometer to identify culture-negative urine specimens in patients with UTI

“…However, UTIs are often harmless and self-eradicated [ 2 ]. Nevertheless, UTIs are associated with high morbidity and costs and especially among patients with diabetes [ 3 ]. In the United States UTIs account annually for more than 7 million physician visits, more than 1 million emergency department visits and more than 100,000 hospitalizations.…”

“…In a large German study on patients with diabetes mellitus type 2 the cost was estimated to €316 per UTI event with a total increased cost of €3916 per patient in the UTI group compared with the non UTI group [ 3 ].…”

Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

“…A study modelling excess costs for diabetes for the year 2040 concluded €4357.73 (46). The comparison of annual healthcare costs of type 2 diabetes patients with and without urinary tract infection results in €4253.26 annual healthcare excess costs (57). Two studies analysed costs for diabetes associated complications: myocardial infarction, stroke or transient ischaemic attack, peripheral vascular disease, coronary heart disease.…”

Costs and its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of economic studies

“…Of these papers, nine papers report 165 cost items on diabetes costs in France (51-59) (all direct costs) and 16 papers report 135 cost items on diabetes costs in Germany of which 131 describe direct costs (36,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73). Cost assessment was based on different numbers of patients ranging from 32 patients in a study performing a survey (72) up to 2.7 million patients in a study analysing health insurance claims data (62).…”

“…All studies included direct costs (36,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73), one study also assessed indirect costs (64) (for detailed results, see tables 5-20; additional material). Except for indirect costs, all costs were presented based on the perspective of statutory health insurances, including only costs that are reimbursed by them.…”