title: An economic perspective on urinary tract infection: the "costs of resignation".
abstract: BACKGROUND
  Urinary tract infection (UTI) is a leading cause of morbidity in the female population, with high levels of prevalence and recurrence within 6 months.
  
  
  OBJECTIVE
  Our objective was to estimate annual costs and health resource utilization by women with UTIs, and the impact on quality of life (QoL) due to lower urinary tract symptoms (LUTS), vaginal pain and dyspareunia. The secondary objective was to estimate the cost per episode of cystitis in a subgroup of patients with recurrent UTIs.
  
  
  METHODS
  We conducted a retrospective analysis of medical records of a cohort of 309 female patients with a history of UTI. Annual costs and costs per episode were estimated as composites of costs per diagnosis, costs per pharmacological therapy and costs per physician visit, according to the Italian National Health Service (NHS) perspective.
  
  
  RESULTS
  The mean number of episodes of cystitis per patient was 4.5 (median [interquartile range, IQR] 3 [1-6]). The mean time from the onset of symptoms was 9 years (median [IQR] 7 [3-11]), excluding 13 % of values missing for this variable. Recurrent UTIs were diagnosed in 122 (39 %) patients. Overall, 243 (78 %) patients had an impaired sex life and 51 (17 %) had interrupted sex lives as a result of UTIs. Patients' median rates of discomfort due to LUTS or dyspareunia on a visual analogue scale (VAS) of 0-10 were 8 (IQR 7-10) and 8 (IQR 8-10), respectively. Mean annual direct cost per patient due to UTI was €229 (median [IQR] €107 [€53-241]), estimated mean direct cost per episode in patients with UTI was €236; whilst in women with recurrent UTI, the mean direct cost per episode was €142 (p < 0.0001).
  
  
  CONCLUSIONS
  Annual mean costs and impact on QoL caused by UTIs are not negligible. Patients resign themselves to the relief of symptoms with recurring UTIs because improvement in health benefit is minimal. Persistence of the disease and the difference in mean costs per episode in patients with recurrent UTIs versus patients with a single episode UTI, which we have called "costs of resignation", suggest that appropriate early evaluation and effective treatment measures for the disease are still difficult in clinical practice.
authors.affiliation: Center for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136 Milan, Italy. oriana.ciani@unibocconi.it
authors.forename: Oriana
authors.initials: O
authors.lastname: Ciani
authors.forename: Daniele
authors.initials: D
authors.lastname: Grassi
authors.forename: Rosanna
authors.initials: R
authors.lastname: Tarricone
mesh_terms: D017281:Cost of Illness; D017050:Episode of Care; D005260:Female; D006801:Humans; D015995:Prevalence; D011788:Quality of Life; D014552:Urinary Tract Infections / Q000191:economics* / Q000453:epidemiology