Skip to main content
SpringerLink
Log in

An Economic Perspective on Urinary Tract Infection: The “Costs of Resignation”

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

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.

Objectives

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.

Design and Participants

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49(2):53–70.

    Article  PubMed  Google Scholar 

  2. Hannan TJ, Mysorekar IU, Hung CS, et al. Early severe inflammatory responses to uropathogenic E. coli predispose to chronic and recurrent urinary tract infection. PLoS Pathog. 2010;6(8):e1001042.

    Article  PubMed  Google Scholar 

  3. Ikaheimo R, Siitonen A, Heiskanen T, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis. 1996;22(1):91–9.

    Article  PubMed  CAS  Google Scholar 

  4. Foxman B, Gillespie B, Koopman J, et al. Risk factors for second urinary tract infection among college women. Am J Epidemiol. 2000;151(12):1194–205.

    Article  PubMed  CAS  Google Scholar 

  5. Sen A. Recurrent cystitis in non-pregnant women. Clin Evid (Online) 2008 Jul 17; 2008. pii: 0801.

  6. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–20.

    Article  PubMed  Google Scholar 

  7. Gupta K, Stamm WE. Pathogenesis and management of recurrent urinary tract infections in women. World J Urol. 1999;17(6):415–20.

    Article  PubMed  CAS  Google Scholar 

  8. Nickel JC. Practical management of recurrent urinary tract infections in premenopausal women. Rev Urol. 2005;7(1):11–7.

    Google Scholar 

  9. Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011;5(5):316–22.

    Article  PubMed  Google Scholar 

  10. Omigie O, Okoror L, Umolu P, Ikuuh G. Increasing resistance to quinolones: a four-year prospective study of urinary tract infection pathogens. Int J Gen Med. 2009;2:171–5.

    PubMed  CAS  Google Scholar 

  11. Grover S, Srivastava A, Lee R, et al. Role of inflammation in bladder function and interstitial cystitis. Ther Adv Urol. 2011;3(1):19–33.

    Article  PubMed  CAS  Google Scholar 

  12. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227–36.

    Article  PubMed  CAS  Google Scholar 

  13. Naber KG, Bergman B, Bishop MC, et al. EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). Eur Urol. 2001;40(5):576–88.

    Article  PubMed  CAS  Google Scholar 

  14. Il portale del Servizio Sanitario Regionale dell’Emilia-Romagna. 2011. http://www.saluter.it/documentazione/leggi/regionali/delibere/aspecialistica-ambulatoriale/dgr.-1065-2006/view?searchterm=None. Accessed 21 Feb 2011.

  15. Agenzia Italiana del Farmaco. 2011. http://www.agenziafarmaco.gov.it/it/content/liste-di-trasparenza-e-rimborsabilita. Accessed 21 Feb 2011.

  16. Miller J, Hoffman E. The causes and consequences of overactive bladder. J Womens Health (Larchmt). 2006;15(3):251–60.

    Article  Google Scholar 

  17. Nosseir SB, Lind LR, Winkler HA. Recurrent uncomplicated urinary tract infections in women: a review. J Womens Health (Larchmt). 2012;21(3):347–54.

    Article  Google Scholar 

  18. Turner D, Little P, Raftery J, et al. Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial. BMJ. 2010;340:c346.

    Article  PubMed  Google Scholar 

  19. Nappi RE, Albani F, Vaccaro P, et al. Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice. Gynecol Endocrinol. 2008;24(4):214–9.

    Article  PubMed  Google Scholar 

  20. Ellis AK, Verma S. Quality of life in women with urinary tract infections: is benign disease a misnomer? J Am Board Fam Pract. 2000;13(6):392–7.

    PubMed  CAS  Google Scholar 

  21. Abrahamian FM, Krishnadasan A, Mower WR, et al. The association of antimicrobial resistance with cure and quality of life among women with acute uncomplicated cystitis. Infection. 2011;39(6):507–14.

    Article  PubMed  CAS  Google Scholar 

  22. Efros M, Bromberg W, Cossu L, et al. Novel concentrated cranberry liquid blend, UTI-STAT with Proantinox, might help prevent recurrent urinary tract infections in women. Urology. 2010;76(4):841–5.

    Article  PubMed  Google Scholar 

  23. Ernst EJ, Ernst ME, Hoehns JD, Bergus GR. Women’s quality of life is decreased by acute cystitis and antibiotic adverse effects associated with treatment. Health Qual Life Outcomes. 2005;3:45.

    Article  PubMed  Google Scholar 

  24. Kaplan RM, Bush JW, Berry CC. Health status: types of validity and the index of well-being. Health Serv Res. 1976;11(4):478–507.

    Google Scholar 

  25. Clayson D, Wild D, Doll H, et al. Validation of a patient-administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire. BJU Int. 2005;96(3):350–9.

    Article  PubMed  Google Scholar 

  26. Bergman J, Gore JL, Singer JS, et al. Readability of health related quality of life instruments in urology. J Urol. 2010;183(5):1977–81.

    Article  PubMed  Google Scholar 

  27. Tannenbaum C, Corcos J. Outcomes in urinary incontinence: reconciling clinical relevance with scientific rigour. Eur Urol. 2008;53(6):1151–61.

    Article  PubMed  Google Scholar 

  28. Lukacz ES, Lawrence JM, Burchette RJ, et al. The use of Visual Analog Scale in urogynecologic research: a psychometric evaluation. Am J Obstet Gynecol. 2004;191(1):165–70.

    Article  PubMed  Google Scholar 

  29. Abdel-Fattah M, Ramsay I, Barrington JW. A simple visual analogue scale to assess the quality of life in women with urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2007;133(1):86–9.

    Article  PubMed  CAS  Google Scholar 

  30. Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care. 1989;27(3 Suppl):S217–32.

    Article  PubMed  CAS  Google Scholar 

  31. Brazier JE, Harper R, Munro J, et al. Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology. 1999;38(9):870–7.

    Article  PubMed  CAS  Google Scholar 

  32. Allen PF, McMillan AS, Walshaw D, Locker D. A comparison of the validity of generic- and disease-specific measures in the assessment of oral health-related quality of life. Community Dent Oral Epidemiol. 1999;27(5):344–52.

    Article  PubMed  CAS  Google Scholar 

  33. Bartoli S, Aguzzi G, Tarricone R. Impact on quality of life of urinary incontinence and overactive bladder: a systematic literature review. Urology. 2010;75(3):491–500.

    Article  PubMed  Google Scholar 

  34. Damiano R, Quarto G, Bava I, et al. Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol. 2011;59(4):645–51.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Noemi Chiara Bindo and Ester Veronesi for their technical support and to the Hesperia Hospital Executive Board who approved the study. Oriana Ciani received support for travel to meetings for the study and administrative assistance sponsored by IBSA. Editorial assistance was provided by Denis Bilotta and Mary Hines of inScience Communications, Springer Healthcare. This assistance was sponsored by IBSA. The design and conduct of the study; the collection, analysis and interpretation of the data; and the preparation, reviewing and approval of the manuscript have been performed exclusively by Oriana Ciani, Daniele Grassi and Rosanna Tarricone.

Author information

Authors and Affiliations

  1. Center for Research on Health and Social Care Management, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy

    Oriana Ciani & Rosanna Tarricone

  2. Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK

    Oriana Ciani

  3. Department of Urology, Hesperia Hospital, Modena, Italy

    Daniele Grassi

  4. Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy

    Rosanna Tarricone

Authors
  1. Oriana Ciani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniele Grassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosanna Tarricone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oriana Ciani.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 27 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ciani, O., Grassi, D. & Tarricone, R. An Economic Perspective on Urinary Tract Infection: The “Costs of Resignation”. Clin Drug Investig 33, 255–261 (2013). https://doi.org/10.1007/s40261-013-0069-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40261-013-0069-x

Keywords

Search

Navigation