Part D data reveals how urologists prescribe antibiotics

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According to the Centers for Disease Control and Prevention, antibiotic resistance is an urgent public health problem responsible for more than 2.8 million infections and more than 35,000 deaths annually in the United States.1 Per capita antibiotic prescriptions vary widely across the United States, and the misuse of antibiotics has undoubtedly contributed to the growing problem of resistance. We know that sepsis after prostate biopsy is more common in patients with a history of previous antibiotic use and is often due to resistant organisms. In this second in a series of articles based on Medicare Part D prescribing data, I will describe urologists’ antibiotic prescribing habits/norms/benchmarks.

The Centers for Medicare & Medicaid Services recently updated its prescription claim information for Medicare beneficiaries enrolled in Part D (prescription drug coverage) aggregated by provider and drug to include data from 2019.2 (About two-thirds of Medicare beneficiaries are enrolled in Part D drug plans.) A related data set includes summary information on opioid and antibiotic prescribing rates. These datasets suppress information on providers or drugs with 10 or fewer claims due to the low chance of identifying a patient, but contain enough information to serve as good benchmarks in my opinion.

A total of 1.5 billion Part D claims involving 1.24 million Medicare providers were submitted in 2019, including 60 million antibiotic claims. The antibiotic prescribing rate can be defined as the number of antibiotic claims/all Part D claims (expressed as %) and averages 4.0% across all specialties. The specialties with the highest antibiotic prescription rates are dental specialties (54%), plastic and reconstructive surgery (30%), infectious diseases (23%) and colorectal surgery (22%). The overall antibiotic prescription rate for urology in Part D was 18%. A total of 117 unique antibiotics were prescribed in 2019; the 20 most prescribed drugs among all providers are listed in Table 1.

In 2019, 8,815 urologists wrote 2.5 million prescriptions (5.4%) for 46 types of antibiotics, the highest ranked non-primary specialty (Table 2). The most common drugs prescribed by urologists in 2019 to Part D recipients were ciprofloxacin hcl, sulfamethoxazole/trimethoprim, cephalexin, and nitrofurantoin (Table 3). Unlike opioids – which urologists tend to have 1 or 2 favorite drugs – most urologists prescribed 3 to 7 different antibiotics in 2019.

How do your habits compare to those of other urologists? To view your data, go to https://bit.ly/3tS5L86, find your national provider ID or name, and scroll to the column marked [Antbtc_Tot_Clms]. Compare your number of antibiotic claims to benchmarks Table 4. For example, if you are associated with 500 antibiotic claims, you have prescribed more antibiotics than 85% of your urology peers in that dataset. Keep in mind that although Medicare beneficiaries typically represent a significant fraction of a urology practice, your prescribing habits reflected here may not be generalizable to all patients.

How do antibiotics contribute to the cost of prescription drugs under the Part D program? Antibiotics are relatively inexpensive drugs, which may contribute to the potential for overuse. The total cost of antibiotic claims in 2019 was $1.5 billion, a small fraction of total Part D expenditures. Urology antibiotic claims totaled only $32 million. There is some cost variation between classes (nitrofurantoin and doxycycline are the most expensive), all of which are readily available as generic drugs (Table 3).

What matters and why it matters

Urologists prescribe antibiotics to Part D recipients in quantities and at higher rates than most other specialists, including surgical specialists; it is the nature of the specialty. It is well established that antibiotic overuse and abuse (eg, inappropriate duration) contribute to community resistance, and urologists are positioned to be important stewards of antibiotic prescribing. Major opportunities in urology include limiting antibiotic prophylaxis to 24 hours. Clinical guidelines and good practice statements for appropriate indications, drugs and durations are available from specialist societies, including the American Urological Association3 and the Infectious Diseases Society of America (https://bit.ly/3K5PvFt). Medicare Part D data on each individual prescriber is readily available to urologists, patients, and the public and can be used to compare your prescribing habits against national and specialty benchmarks.

References

1. Prescription and use of antibiotics. Centers for Control and Prevention of Disasters. Updated October 7, 2021. Accessed April 21, 2022. https://bit.ly/3xRACUV

2. Medicare Part D prescribers – by provider and drug. Medicare and Medicaid Service Centers. Updated August 31, 2021. Accessed April 21, 2022. https://bit.ly/3qO8wFE

3. Urological Procedures and Antimicrobial Prophylaxis (2019). American Urological Association. June 2019. Accessed April 21, 2022. https://bit.ly/3rLDWgb

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