Economic assessment of three antimicrobial therapies for uncomplicated urinary tract infection in women

This retrospective cohort study used North Carolina Medicaid paid-claims da ta to assess clinical and economic outcomes of treatments for urinary tract infection (UTI). The study population comprised female Medicaid recipients , between 15 and 64 years of age, with a paid claim filed for a primary dia gnosis of UTI or acute UTI from January 1 to June 30, 1994, who were treate d with ciprofloxacin, nitrofurantoin, or trimethoprim/sulfamethoxazole (TMP /SMZ). Patients had follow-up for 6 months after the primary diagnosis. Pat ients who did not receive further treatment for UTI with 1 of the 3 drugs w ithin 30 days after initial treatment were assumed to be cured. Costs were measured as the sum of reimbursements for UTI-related medical services and drug treatments. Outcomes for 409 patients were assessed. Cure rates of ini tial treatment with ciprofloxacin, nitrofurantoin, and TMP/SMZ were 81%, 88 %, and 93%, respectively. Cost-effectiveness ratios of initial treatment wi th the 3 drugs were $150.80, $81.20, and $69.00, respectively. When efficac y rates generated from published randomized clinical studies were applied, cost-effectiveness ratios for the 3 drugs were $130.96, $86.17, and $72.00, respectively. A decision model of treatment pattern and associated costs i s presented. Several patient variables indicate that the ciprofloxacin grou p included more severe cases of UTI than did the other groups. Study limita tions, confounders, and future research suggestions are discussed. Our resu lts show that treatment for >7 days results in a better cure rate regardles s of the drug used than does treatment for less than or equal to 7 days and that TMP/SMZ is the most cost-effective of the 3 drugs for UTI or acute UT I.