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Abstract
This retrospective cohort study used North Carolina Medicaid paid-claims data 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 diagnosis of UTI or acute UTI from January
1 to June 30, 1994, who were treated with ciprofloxacin, nitrofurantoin, or trimethoprim/sulfamethoxazole
(TMP/SMZ). Patients had follow-up for 6 months after the primary diagnosis. Patients
who did not receive further treatment for UTI with 1 of the 3 drugs within 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 initial treatment with ciprofloxacin, nitrofurantoin,
and TMP/SMZ were 81%, 88%, and 93%, respectively. Cost-effectiveness ratios of initial
treatment with the 3 drugs were $150.80, $81.20, and $69.00, respectively. When efficacy
rates generated from published randomized clinical studies were applied, costeffectiveness
ratios for the 3 drugs were $130.96, $86.17, and $72.00, respectively. A decision
model of treatment pattern and associated costs is presented. Several patient variables
indicate that the ciprofloxacin group included more severe cases of UTI than did the
other groups. Study limitations, confounders, and future research suggestions are
discussed. Our results show that treatment for >7 days results in a better cure rate
regardless of the drug used than does treatment for ≤7 days and that TMP/SMZ is the
most cost-effective of the 3 drugs for UTI or acute UTI.
Key words
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Article info
Publication history
Accepted:
May 8,
1999
Identification
Copyright
© 1999 Published by Elsevier Inc.
