BACKGROUND: Symptoms associated with urinary tract infection (UTI) are common in women in general practice and represent a significant burden for the National Health Service. There is considerable variation among general practitioners in the management of patients presenting with these symptoms. AIM: To identify the most appropriate patient management strategy given current information for non-pregnant, adult women presenting in general practice with symptoms of uncomplicated UTI. METHOD: A decision analytic model incorporating a variety of patient management strategies was constructed using available published information and expert opinion. This model was able to provide guidance on current best practice based upon cost-effectiveness (cost per symptom-free day). RESULTS: Empiric treatment was found to be the least costly strategy available. It saved two days of symptoms per episode of UTI at a cost of 14 Pounds. The empiric-and-laboratory strategy involves an incremental cost-effectiveness ratio of 215 Pounds per symptom day averted per episode of UTI. The remaining patient management strategies are never optimal. CONCLUSION: Empiric treatment of patients presenting with symptoms of UTI was found to be cost-effective under a range of assumptions for this patient group. However, recognition of the impact of this strategy upon antibiotic resistance may lead to the dipstick strategy being considered a superior strategy overall.
BACKGROUND: Symptoms associated with urinary tract infection (UTI) are common in women in general practice and represent a significant burden for the National Health Service. There is considerable variation among general practitioners in the management of patients presenting with these symptoms. AIM: To identify the most appropriate patient management strategy given current information for non-pregnant, adult women presenting in general practice with symptoms of uncomplicated UTI. METHOD: A decision analytic model incorporating a variety of patient management strategies was constructed using available published information and expert opinion. This model was able to provide guidance on current best practice based upon cost-effectiveness (cost per symptom-free day). RESULTS: Empiric treatment was found to be the least costly strategy available. It saved two days of symptoms per episode of UTI at a cost of 14 Pounds. The empiric-and-laboratory strategy involves an incremental cost-effectiveness ratio of 215 Pounds per symptom day averted per episode of UTI. The remaining patient management strategies are never optimal. CONCLUSION: Empiric treatment of patients presenting with symptoms of UTI was found to be cost-effective under a range of assumptions for this patient group. However, recognition of the impact of this strategy upon antibiotic resistance may lead to the dipstick strategy being considered a superior strategy overall.
Authors: W S Smellie; J O Forth; C A M McNulty; L Hirschowitz; D Lilic; R Gosling; D Bareford; E Logan; K G Kerr; G P Spickett; J Hoffman; A Galloway; C A Bloxham Journal: J Clin Pathol Date: 2006-02 Impact factor: 3.411
Authors: Bart J Knottnerus; Suzanne E Geerlings; Eric P Moll van Charante; Gerben Ter Riet Journal: Ann Fam Med Date: 2013 Sep-Oct Impact factor: 5.166