Costos de atención domiciliaria de nivel hospitalario vs. atención intrahospitalaria en infección de vías urinarias complicada*

Objective: To evaluate the difference costs considering a third-party payer perspective in patients with complicated urinary tract infection between a hospital-level home care service and standard hospitalization.

Methods: Retrospective cohort study, retrieving medical records of patients with complicated urinary tract infection diagnosis treated at a fourth-level hospital, from January 2017 to May 2020. A linear regression model was obtained to evaluate cost per day attention determinants.

Results: 239 patients were included in the hospitalized group and 68 in the hospital-level home care group. The in-hospital cohort was older (median 71 vs 59 years, p=0.002). There were no differences in 30-day mortality rate (2.1% vs 5.9%, p=0.114) or total costs of attention (Colombian pesos (COP) 8767141 vs 9558334, p= 0.112). A longer clinical attention (median 17 vs 12 days, p<0.001) and a lower cost/day were found in patients hospitalized at home (COP 756100 vs 554685, p<0.001).The following factors were associated with increased cost/day: hospital-level home care (COP –209155, p=0.01), Charlson index ≥6 (COP 26250, p=0.001), surgical procedures (COP 368157, p<0.001), Intensive Care Unit requirement (COP 373927, p<0.001), subsidized regimen (COP 209156, p=0.013), staphylococcus isolation (COP 1252473, p<0.001) and carbapenemase-producing germs (COP 629319, p<0.001).

Conclusions: This study suggests that cost/day attention for patients with complicated urinary tract infection is lower in patient treated by a hospital-level home service. However, the total costs are similar. Additionally, hospital-level home service is secure.