Medical Claims for UTI-Related Infections More Common Among Patients With MS

Medical claims associated with urinary tract infection (UTI)-related infections, especially in higher-intensity care settings, are more common among patients with multiple sclerosis (MS) compared with individuals without MS, according to study results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2023, held in San Diego, California, from February 23 to 25.

People with MS have a higher risk for UTI-related hospitalization and death. Bladder dysfunction, catheter use, and treatments that impact the immune system are considered risk factors for UTIs in this patient population. UTIs can exacerbate neurologic symptoms in MS that resemble a clinical relapse, thus, making it complicated for non-MS specialists to tell the difference.

To characterize UTI-related care settings in the MS population, researchers collected longitudinal data of commercially insured patients with MS and age-/sex-matched control individuals. Researchers used a large payer commercial claims database to analyze information related to medical and prescription coverage from 2016 to 2020.

For the MS cohort, inclusion criteria included a birth year before 1997 and the combination of any 3 nonoverlapping claims with an MS diagnosis code (G35) or disease-modifying therapy within a year following the first G35. Individuals who met the criteria were included in the study for a total of 5 years. The researchers used random sampling that was vetted by age and sex to select the matched control cohort.

Diagnosis codes related to UTIs included UTI (N39.0), cystitis (N30.*), and pyelonephritis (N10) in any position. Emergency room (ER) and inpatient care were used to indicate place of service.

A total of 17,745 patients with and 17.745 matched control participants without MS were included in the analysis.

In the 5-year study period, 32%, 5.6%, and 3.3% of patients with MS had at least 1 UTI-related medical claim in any setting, the ER or inpatient setting, and inpatient setting, respectively. The likelihood of having at least 1 medical claim related to a UTI diagnosis code among individuals in the MS cohort compared with those in the control cohort was:

• 1.8 times (95% CI, 1.7-1.9) higher for any claim;
• 2.6 times (95% CI, 2.3-2.9) higher for an ER or inpatient claim; and
• 4.0 times (95% CI, 3.3-4.8) higher for an inpatient claim.

UTI, cystitis, and pyelonephritis were among the most common primary diagnoses in the ER, whereas MS, sepsis, and UTI were the most common in inpatient care.

Overall, the researchers found that compared with individuals without MS, patients with MS who were commercially insured were more likely to have medical claims tied to UTI-related infections in higher-intensity care settings.

“Early intervention strategies addressing UTI prior to the patient seeking emergency care could potentially both improve the care and lower the cost profile of patients [with MS],” the researchers concluded.

They noted further investigation is warranted to better understand drivers of UTI-related care rates and develop strategies for effective interventions in this patient population.