An economic perspective on urinary tract infection: the "costs of resignation"

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 a composite of costs per diagnosis, costs per pharmacologic therapy and costs per physician visit, according to the Italian NHS perspective. Results: The mean number of episodes of cystitis per patient was 4.5 and the median time from the onset of symptoms was 7 years (interquartile range (IQR): 3-11). Recurrent UTIs were diagnosed in 122 (39%) patients. Overall, 243 (78%) patients had an impaired sexual life and 51 (17%) had interrupted sexual lives as a result of UTIs. Patients’ median rates of discomfort due to LUTS or dyspareunia on a VAS scale of 0-10 were 8 (IQR 7-10) and 8 (IQR 8-10), respectively. Annual patient direct costs due to UTI were €229 (median €107, IQR €53─241), estimated cost per episode in patients with UTI was €236, whilst in women with recurrent UTI the cost per episode was €142 (p˂0.000). Conclusion: Annual costs and impact on quality of life caused by UTIs are not negligible. Persistence of the disease and the difference in costs per episode in recurrent UTI vs. UTI patients, 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.