Real-World Evidence That a Novel Diagnostic Combining Molecular Testing With Pooled Antibiotic Susceptibility Testing is Associated With Reduced Infection Severity and Lower Cost Compared With Standard Urine Culture in Patients With Complicated or Persistently Recurrent Urinary Tract Infections

Abstract

Purpose: Develop real-world evidence that rapid identification of uropathogens and susceptibilities improves urologic outcomes for patients with complicated or history of recurrent urinary tract infections (r/cUTIs). Standard urine culture (SUC) is slow, often missing polymicrobial infections and altered antibiotic resistance from their metabolic interactions. Materials and Methods: We compared 1-year UTI-related health care utilization and costs for UTIs diagnosed by outpatient multiplex polymerase chain reaction/pooled antibiotic susceptibility testing (mPCR/P-AST) vs SUC among Medicare beneficiaries with r/cUTIs, using claims from a deidentified random 5% sample of beneficiaries with an index UTI in 2018 followed by 12 months during which all outpatient UTI tests were either mPCR/P-AST or SUC. Outcomes were compared between 69 individuals diagnosed using mPCR/P-AST and 678 propensity-matched individuals using SUC. Regression models modeled cost differences with 95% confidence intervals (CIs). Results: Of 1,654,548 enrollees in 2018, 11.6%, 0.06%, and 9.6% had claims for UTI, mPCR/P-AST, and SUC, respectively. The matched mPCR/P-AST and SUC cohorts were statistically equivalent at baseline. The mPCR/P-AST cohort was nonsignificantly less likely than the SUC cohort to have a postindex UTI (65.2% vs 72.0%, P = .24). Cost per subsequent UTI was significantly lower for mPCR/P-AST ($767 vs $1,303, P = .0013). Average total 1-year UTI-related cost was $501.85 (95% CI: $79.87, $562.08 P = .004) lower per mPCR/P-AST member vs SUC ($629.55 vs $1131.39). Nonoutpatient treatment accounted for 22.5% of mPCR/P-AST vs 53.4% of SUC UTI-related costs. Conclusions: In patients with r/cUTI, rapid identification of pathogens and antibiotic susceptibilities using mPCR/P-AST is associated with lower UTI-related clinical care and utilization costs compared with SUC.