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

Objective: to compare the costs of care in patients with complicated urinary tract infection between a hospital level home care service (HHUS) and intramural hospitalization. Methods: cost study based on retrospective cohorts of patients with complicated urinary tract infection treated in a high complexity university hospital. A generalized linear model was used to evaluate the determinants of cost/day of care. Results: 239 patients were included in the in-hospital care group and 68 patients in SADNH. The in-hospital cohort was older (median 71 vs. 59 years, p=0.002). There were no differences in mortality (2.1% vs. 5.9%; p=0.114) or unscheduled readmission (11.7% vs. 13.2%; p=0.679). In addition, there was evidence of longer care in SADNH (median 17 vs. 12 days; p<0.001). In the unadjusted analysis, total costs were similar (COP 8767141 vs. 9558334; p=0.112), but cost/day was lower for the SADNH model (COP 756100 vs. 554685; p<0.001). The generalized linear model showed that cost/day was 20.4% higher for intramural care compared to SADNH (p=0.039). Additionally, it was 19% higher in women (p=0.005), 54.9% higher among those requiring ICU (p<0.001), and 7.3 times higher among those requiring any surgical procedure. Additionally, the cost/day was significantly higher among those who had isolation of pseudomonas (p<0.001), carbapenemase-producing germ (p<0.001) and staphylococcus (p<0.001). Conclusions: this study suggests that the cost/day of care for patients with complicated urinary tract infection is lower in home care. However, total costs are similar. Additionally, home care suggests to be safe.