Abstract
BackgroundUrinary tract infections (UTI) are one of the most common infections treated in primary care and the emergency department. The RxOUTMAP study demonstrated that management of uncomplicated UTI by community pharmacists resulted in high clinical cure rates similar to those reported in the literature and a high degree of patient satisfaction. The objective of this study was to assess the cost-effectiveness and budget impact of community pharmacist-initiated compared to family or emergency physician-initiated management of uncomplicated UTI.MethodsA decision analytic model was used to compare costs and outcomes of community pharmacist-initiated management of uncomplicated UTI to family or emergency physician-initiated management. Cure rates and utilities were derived from published studies. Costs of antibiotic treatment and health services use were calculated based on cost data from Canada. We used a probabilistic analysis to evaluate the impact of treatment strategies on costs and quality-adjusted-life-months (QALMs). In addition, a budget impact analysis was conducted to evaluate the financial impact of community pharmacist-initiated uncomplicated UTI management in this target population. This study was conducted from the perspective of the public health care system of Canada.ResultsPharmacist-initiated management was lower cost ($72.47) when compared to family and emergency physician-initiated management, $141.53 and $368.16, respectively. The QALMs gained were comparable across the management strategies. If even only 25% of Canadians with uncomplicated UTI were managed by community pharmacists over the next 5 years, the resulting net total savings was estimated at $51 million.ConclusionFrom a Canadian public health care system perspective, community pharmacist-initiated management would likely be a cost-effective strategy for uncomplicated UTI. In an era of limited health care resources, expanded roles of community pharmacists or other non-physician community based prescribers are important mechanisms through which accessible, high-quality and cost-effective care may be achieved. Further studies to evaluate other conditions which can be managed in the community and their cost effectiveness are essential.
Highlights
Urinary tract infections (UTI) are one of the most common infections treated in primary care and the emergency department
Urinary tract infection (UTI) is one of the most common bacterial infections seen in primary care affecting about 12–15% of women annually and 50% of women by 32 years of age. [1, 2] It is associated with lower abdominal pain, discomfort, and stress that can significantly affect quality-of-life
We conducted an economic evaluation in the form of a cost-effectiveness analysis, of the RxOUTMAP study, a prospective study of community pharmacist prescribing and care for women presenting with uncomplicated UTI in New Brunswick between June 2017 to April 2018
Summary
Urinary tract infections (UTI) are one of the most common infections treated in primary care and the emergency department. Urinary tract infection (UTI) is one of the most common bacterial infections seen in primary care affecting about 12–15% of women annually and 50% of women by 32 years of age. Community pharmacies provide an opportunity for patients to access a regulated health care professional (i.e., pharmacists) without an appointment to seek treatment for uncomplicated UTI among other conditions. This enables pharmacists to assess patients, implement appropriate antibiotics (if necessary), reduce the burden on other areas of the health care system, help patients access care during or after working hours, and provide economically efficient delivery of health care
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