PUK8 Water: A Prevention Strategy to Decrease the Economic Burden of Recurrent Cystitis Among Women in the United States of America

Abstract

Urinary tract infections (UTI) are common, highly prevalent in women and represent a substantial economic burden to the healthcare system. In the present study, we estimated the budgetary impact of preventing UTI by increasing water intake in American women with low fluid intake and recurrent cystitis. A Markov model was developed to compare costs and clinical outcomes between usual fluid intake vs. an additional 1.5L/day of water in American women with low fluid intake and recurrent cystitis. Model assumptions included results from a randomized controlled trial reporting increasing water intake by 1.5L/day over usual fluid intake decreased by 48% the risk of developing cystitis in this target population. Outcomes were based on payer perspective and included both direct costs (general practitioner visit, dipstick, urinalysis, antibiotic treatment, pyelonephritis complications and water) and indirect costs (work loss). Costs were adjusted for inflation and updated to 2019 using the country-specific consumer price index and are reported in U.S. dollars ($). A 10-year follow-up period was considered to capture the impact of the prevention strategy on the long-term morbi-mortality resulting from UTI complications. Total UTI cost per person was $1,353, with direct costs of $676. Considering the target population, this corresponded to an annual budget impact of $806 million. Assuming a gradual increase in compliance with high water intake recommendation, from 10% in the first year to 80% after 10 years, 4,170,926 cystitis events and 250,256 pyelonephritis events could be prevented over 10 years, resulting in a cumulative cost saving of $1.5 billion. Even when considering 10% compliance, 89,449 fewer cystitis, 5,367 fewer pyelonephritis and an associated budget saving of $33 million would be expected. Increasing water intake can reduce the economic burden associated to cystitis, resulting in significant cost savings for the US payers.