The multiplex polymerase chain reaction/pooled antibiotic susceptibility test was associated with a 44.4% lower mean total UTI-related cost compared to standard urine culture.
Urinary tract infection (UTI)-related health care utilization, costs, and antibiotic resistance were found to be lower among patients who were given a diagnosis by an outpatient multiplex polymerase chain reaction/pooled antibiotic susceptibility test (mPCR/P-AST) compared with those given a diagnosis by a standard urine culture (SUC).1
The data were published in JU Open Plus2 and Infection and Drug Resistance.3
To assess health care utilization and costs,2 investigators analyzed Medicare claims from a randomized sample of 5% of beneficiaries enrolled in Medicare Parts A+B who had recurrent or complicated UTIs (r/cUTIs). Among those, 69 were given a diagnosis using mPCR-P-AST via the Guidance UTI test and 678 were given a diagnosis using a SUC. The 2 cohorts were propensity matched.
The mPCR-P-AST group was found to have experienced a 41.3% lower medical resource utilization (MRU) rate, defined as at least 1 urgent care, emergency, acute inpatient, or skilled nursing facility event, compared with the SUC group.
Further, patients in the mPCR/P-AST cohort were less likely to experience a second unique UTI compared with those in the SUC cohort, though the difference did not reach statistical significance (65.2% vs 72.0%, P = .24). The mean number of additional UTIs was 1.83 in the mPCR/P-AST cohort, compared with 2.23 for patients in the SUC cohort (P = .17). The cost per cohort member with a subsequent UTI was also lower among the mPCR/P-AST group, with a mean cost of $767.48, compared with $1303.20 in the SUC group (P = .049).
Further, over 1 year, the investigators found that mean total UTI-related cost for mPCR/P-AST episodes was 44.4% lower compared with that for SUC episodes, with an average cost of $629.55 for mPCR/P-AST episodes compared with $1131.30 for SUC episodes (P = .004). The use of mPCR/P-AST for all cases would have led to a projected savings of around $181 million per year, excluding cost differences in outpatient labs or pharmacies.
Similarly, patients in the mPCR/P-AST cohort experienced a 76.6% lower cost among UTI-related composite MRU compared with those in the SUC cohort ($141.60 vs $605.06, P = .043). Specifically, MRU costs accounted for 22.5% of UTI-related costs for patients who received a mPCR-P-AST, compared with 53.4% for those who received a SUC.
The authors wrote, “Considering the composite measure to represent clinically advanced UTI, we attribute the lower costs in the mPCR/P-AST cohort to the rapid and accurate diagnostic strategy allowing for early intervention and avoiding delays in treatment resulting from the typical 2 to 4 days of SUC result reporting.”
The remaining costs related to nonurgent outpatient care were found to be similar among the groups.
Further benefit of the mPCR/P-AST test was demonstrated in a separate study published in Infection and Drug Resistance,3 where investigators presented findings from an observational, prospective study assessing antibiotic resistance among patients who received a mPCR/P-AST test (n =52) for UTIs compared with those who did not (n = 12).
Data showed a 42.3% reduction in resistants antibiotics among patients who underwent testing, compared with an 8.3% reduction among those who did not (P = .04). Further, a 38.5% reduction in ABR gene detection was observed among the cohort of patients who underwent testing, compared with a 0% reduction among those who did not (P = .01).
The study is still ongoing.
1. Newly published data demonstrated positive outcomes resulting from Pathnostics’ advanced urinary tract infection (UTI) test. News release. Pathnostics. June 20, 2023. Accessed June 23, 2023. https://www.prnewswire.com/news-releases/newly-published-data-demonstrates-positive-outcomes-resulting-from-pathnostics-advanced-urinary-tract-infection-uti-test-301853179.html
2. Ko SCD, Lukacz ES, Juster IA, et al. 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. JU Open Plus. Published online May 2023. Accessed June 23, 2023. doi:10.1097/JU9.0000000000000025
3. Korman HJ, Mathur M, Luke N, et al. Multiplex polymerase chain reaction/pooled antibiotic susceptibility testing was not associated with increased antibiotic resistance in management of complicated urinary tract infections. Infect Drug Resist. Published online May 9, 2023. Accessed June 23, 2023. doi:10.2147/IDR.S406745