Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model.
BACKGROUND
Recurrent urinary tract infections (UTIs) are a common problem among women. However, comparative effectiveness strategies for managing recurrent UTIs are lacking.


METHODS
We performed a systematic literature review of management of women experiencing ≥3 UTIs per year. We then developed a Markov chain Monte Carlo model of recurrent UTI for each management strategy with ≥2 adequate trials published. We simulated a cohort that experienced 3 UTIs/year and a secondary cohort that experienced 8 UTIs/year. Model outcomes were treatment efficacy, patient and payer cost, and health-related quality of life.


RESULTS
Five strategies had ≥2 clinical trials published: (1) daily antibiotic (nitrofurantoin) prophylaxis; (2) daily estrogen prophylaxis; (3) daily cranberry prophylaxis; (4) acupuncture prophylaxis; and (5) symptomatic self-treatment. In the 3 UTIs/year model, nitrofurantoin prophylaxis was most effective, reducing the UTI rate to 0.4 UTIs/year, and the most expensive to the payer ($821/year). All other strategies resulted in payer cost savings but were less efficacious. Symptomatic self-treatment was the only strategy that resulted in patient cost savings, and was the most favorable strategy in term of cost per quality-adjusted life-year (QALY) gained.


CONCLUSIONS
Daily antibiotic use is the most effective strategy for recurrent UTI prevention compared to daily cranberry pills, daily estrogen therapy, and acupuncture. Cost savings to payers and patients were seen for most regimens, and improvement in QALYs were seen with all. Our findings provide clinically meaningful data to guide the physician-patient partnership in determining a preferred method of prevention for this common clinical problem.
Division of Infectious Diseases, Clinical Outcomes Research Unit, Los Angeles Biomedical Research Institute.
Samantha J
SJ
Eells
Kiran
K
Bharadwa
James A
JA
McKinnell
Loren G
LG
Miller
D026881:Acupuncture; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control* / Q000628:therapy*; D029799:Vaccinium macrocarpon
D000900:Anti-Bacterial Agents; D004967:Estrogens
management; recurrent; urinary tract infection