Assessing the economic burden of complicated urinary tract infection: A systematic literature review

Complicated urinary tract infections (cUTIs) arise in patients with structural or functional abnormalities of the genitourinary tract or those with nonurogenital comorbidities. cUTIs can be associated with high healthcare resource utilization (HCRU). We conducted a systematic literature review (SLR) to understand the economic burden of cUTI in a selection of countries likely to have early adoption of innovative antibiotic combination regimens.

The SLR was conducted to identify observational studies evaluating the burden of cUTI in France, Italy, Germany, Spain, the United Kingdom, China, Japan, and the United States (US) for 2013-2023 (PROSPERO-CRD42023454794) using PubMed, Embase, Cochrane, and EconLit databases, with no language limitations.

Of 1,041 studies identified, 154 from databases were selected for full-text review; of these, 53 met the economic inclusion criteria, reporting direct costs and/or healthcare utilization. Mean hospitalization costs per cUTI varied from $2,747 in China to $32,790 for catheter-associated UTI (CAUTI) acquired in the hospital among US children. Length of stay (LOS) was the most common HCRU outcome reported. Across 3 multicountry studies, LOS for cUTI hospitalization was similar, with a median length of 7 days. Patients with CAUTI had longer LOS than did controls.

Available evidence from the US studies indicates that economic burden associated with cUTI is substantial. However, except for the US, direct costs were missing or reported in only 1 or 2 studies for each of the other countries examined. Similarly, HCRU outcomes were missing or reported in only a few studies, except for the US and Spain.