Abstract
BackgroundUrinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs.ObjectiveTo evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) over a 12 month period in premenopausal women with recurrent UTIs.Materials and MethodsAn economic evaluation was performed alongside a randomized trial. Primary outcome was the number of UTIs during 12 months. Secondary outcomes included satisfaction and quality of life. Healthcare utilization was measured using questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to evaluate the cost-effectiveness of the treatments.ResultsCranberry prophylaxis was less effective than TMP-SMX prophylaxis, but the differences in clinical outcomes were not statistically significant. Costs after 12 months in the cranberry group were statistically significantly higher than in the TMP-SMX group (mean difference €249, 95% confidence interval 70 to 516). Cost-effectiveness planes and cost-effectiveness acceptability curves showed that cranberry prophylaxis to prevent UTIs is less effective and more expensive than (dominated by) TMP-SMX prophylaxis.ConclusionIn premenopausal women with recurrent UTIs, cranberry prophylaxis is not cost-effective compared to TMP-SMX prophylaxis. However, it was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs. Moreover, although we based the dosage of cranberry extract on available evidence, this may not be the optimal dosage. Results may change when this optimal dosage is identified.Trial RegistrationISRCTN.org ISRCTN50717094
Highlights
Urinary Tract Infections (UTIs) are very common, especially in women
Cost-effectiveness planes and costeffectiveness acceptability curves showed that cranberry prophylaxis to prevent Urinary tract infections (UTIs) is less effective and more expensive than TMP-SMX prophylaxis
It was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs
Summary
Urinary Tract Infections (UTIs) are very common, especially in women. Acute UTI is considered a benign condition, acute UTI can have negative consequences. Women find the main symptoms of UTI, painful and frequent micturition, bothersome and these symptoms have a negative impact on quality of life [2,3,4,5]. The high incidence of UTI results in considerable costs due to physician visits, diagnostic tests and medication. It was estimated that total costs due to UTI amounted to $2.3 billion in the US in 2010 [6]. Urinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs
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