THE COST-EFFECTIVENESS OF PLACING URINARY-TRACT INFECTION TREATMENT OVER-THE-COUNTER

We use cost-effectiveness analysis to estimate the economic and health implications of approving the over-the-counter sale of oral antibioti cs for treatment of urinary tract infection (UTI). We consider two alt ernatives for over the-counter availability and examine the reduced ec onomic cost from avoided doctors' visits, along with the potential add itional costs associated with higher over-the counter treatment prices or increased use due to greater access. We also consider important no neconomic costs such as reduced symptom days, restricted activity days , and growing resistance to antibiotics. Our analysis covers a 20-year time horizon to capture the long-term effects, from a societal perspe ctive, of a policy decision to place UTI treatment over the counter to day. In addition, we present sensitivity analyses to test the effects of the assumptions in our model. We estimate that the economic costs o f placing UTI treatment over the counter outweigh the benefits, unless there is extensive patient education and a mechanism for allowing pat ients to properly self diagnose to reduce markedly the number of docto rs' visits, mistreated symptoms, and threat of resistance to antibioti cs. Only if doctors' visits were reduced to 64.6% of current levels wo uld the economic benefits of over-the counter treatment begin to be re alized. UTI is one of the most common complaints among women and accou nts for a large number of doctor visits each year. However, the costs of over-the counter distribution of UTI treatment, particularly those due to the risk of decreasing the time until standard treatments becom e ineffective due to bacterial resistance, out weigh the short-term ga ins of decreased symptom days and increased access to treatment.