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Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey

Authors: M. François, T. Hanslik, B. Dervaux, Y. Le Strat, C. Souty, S. Vaux, S. Maugat, C. Rondet, M. Sarazin, B. Heym, B. Coignard, L. Rossignol

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Urinary tract infections (UTIs) are among the most common bacterial infections. Despite this burden, there are few studies of the costs of UTIs. The objective of this study was to determine the costs of UTIs in women over 18 years of age who visit general practitioners in France.

Methods

The direct and indirect costs of clinical UTIs were estimated from societal, French National Health Insurance and patient perspectives. The study population was derived from a national cross-sectional survey entitled the Drug-Resistant Urinary Tract Infection (Druti). The Druti included every woman over 18 years of age who presented with symptoms of UTI and was conducted in France in 2012 and 2013 to estimate the annual incidence of UTIs due to antibiotic-resistant Enterobacteriaceae in women visiting general practitioners (GPs) for suspected UTIs.

Results

Of the 538 women included in Druti, 460 were followed over 8 weeks and included in the cost analysis. The mean age of the women was 46 years old. The median cost of care for one episode of a suspected UTI was €38, and the mean cost was €70. The annual societal cost was €58 million, and €29 million of this was reimbursed by the French National Health Insurance system. In 25 % of the cases, the suspected UTIs were associated with negative urine cultures. The societal cost of these suspected UTIs with negative urine cultures was €13.5 million. No significant difference was found between the costs of the UTIs due to antibiotic-resistant E. coli and those due to wild E. coli (p = 0.63).

Conclusion

In the current context in which the care costs are continually increasing, the results of this study suggests that it is possible to decrease the cost of UTIs by reducing the costs of suspected UTIs and unnecessary treatments, as well as limiting the use of non-recommended tests.
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Literature
1.
go back to reference Nicolle LE. Epidemiology of urinary tract infections. Clin Microbiol Newsl. 2002;24(18):135–40.CrossRef Nicolle LE. Epidemiology of urinary tract infections. Clin Microbiol Newsl. 2002;24(18):135–40.CrossRef
2.
go back to reference Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113(1):5–13.CrossRef Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113(1):5–13.CrossRef
3.
go back to reference Kunin CM. Urinary tract infections in females. Clin Infect Dis Off Publ Infect Dis Soc Am. 1994;18(1):1–10. quiz 11–2.CrossRef Kunin CM. Urinary tract infections in females. Clin Infect Dis Off Publ Infect Dis Soc Am. 1994;18(1):1–10. quiz 11–2.CrossRef
4.
go back to reference Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10(8):509–15.CrossRefPubMed Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000;10(8):509–15.CrossRefPubMed
5.
go back to reference Laupland KB, Ross T, Pitout JDD, Church DL, Gregson DB. Community-onset urinary tract infections: a population-based assessment. Infection. 2007;35(3):150–3.CrossRefPubMed Laupland KB, Ross T, Pitout JDD, Church DL, Gregson DB. Community-onset urinary tract infections: a population-based assessment. Infection. 2007;35(3):150–3.CrossRefPubMed
6.
go back to reference Le TP, Miller LG. Empirical therapy for uncomplicated urinary tract infections in an era of increasing antimicrobial resistance: a decision and cost analysis. Clin Infect Dis. 2001;33(5):615–21.CrossRefPubMed Le TP, Miller LG. Empirical therapy for uncomplicated urinary tract infections in an era of increasing antimicrobial resistance: a decision and cost analysis. Clin Infect Dis. 2001;33(5):615–21.CrossRefPubMed
7.
go back to reference Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet Lond Engl. 2005;365(9459):579–87.CrossRef Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet Lond Engl. 2005;365(9459):579–87.CrossRef
8.
go back to reference Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096.CrossRefPubMed Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096.CrossRefPubMed
9.
go back to reference Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O’Kelly F, Flynn RJ, et al. The changing pattern of antimicrobial resistance within 42 033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999–2009. BJU Int. 2012;109(8):1198–206.CrossRefPubMed Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O’Kelly F, Flynn RJ, et al. The changing pattern of antimicrobial resistance within 42 033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999–2009. BJU Int. 2012;109(8):1198–206.CrossRefPubMed
10.
go back to reference Ikäheimo R, Siitonen A, Heiskanen T, Kärkkäinen U, Kuosmanen P, Lipponen P, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis Off Publ Infect Dis Soc Am. 1996;22(1):91–9.CrossRef Ikäheimo R, Siitonen A, Heiskanen T, Kärkkäinen U, Kuosmanen P, Lipponen P, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis Off Publ Infect Dis Soc Am. 1996;22(1):91–9.CrossRef
11.
go back to reference Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States. Ambul Outreach. 1996;1998:8–11. Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States. Ambul Outreach. 1996;1998:8–11.
12.
go back to reference Rosenberg M. Pharmacoeconomics of treating uncomplicated urinary tract infections. Int J Antimicrob Agents. 1999;11(3–4):247–51. discussion 261–4.CrossRefPubMed Rosenberg M. Pharmacoeconomics of treating uncomplicated urinary tract infections. Int J Antimicrob Agents. 1999;11(3–4):247–51. discussion 261–4.CrossRefPubMed
13.
go back to reference Flahault A, Blanchon T, Dorléans Y, Toubiana L, Vibert JF, Valleron AJ. Virtual surveillance of communicable diseases: a 20-year experience in France. Stat Methods Med Res. 2006;15(5):413–21.CrossRefPubMed Flahault A, Blanchon T, Dorléans Y, Toubiana L, Vibert JF, Valleron AJ. Virtual surveillance of communicable diseases: a 20-year experience in France. Stat Methods Med Res. 2006;15(5):413–21.CrossRefPubMed
14.
go back to reference Rossignol L, Maugat S, Blake A, Vaux S, Heym B, Le Strat Y, et al. Risk factors for resistance in urinary tract infections in women in general practice: A cross-sectional survey. J Infect. 2015;71(3):302–11. Rossignol L, Maugat S, Blake A, Vaux S, Heym B, Le Strat Y, et al. Risk factors for resistance in urinary tract infections in women in general practice: A cross-sectional survey. J Infect. 2015;71(3):302–11.
18.
go back to reference Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–68.CrossRefPubMed Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–68.CrossRefPubMed
19.
go back to reference Franco AVM. Recurrent urinary tract infections. Best Pract Res Clin Obstet Gynaecol. 2005;19(6):861–73.CrossRefPubMed Franco AVM. Recurrent urinary tract infections. Best Pract Res Clin Obstet Gynaecol. 2005;19(6):861–73.CrossRefPubMed
22.
go back to reference De Roquefeuil L, Studer A, Neumann A, Merliere Y. L’échantillon généraliste de bénéficiaires : représentativité, portée et limites. Prat Organ Soins. 2009;40(3):213–23.CrossRef De Roquefeuil L, Studer A, Neumann A, Merliere Y. L’échantillon généraliste de bénéficiaires : représentativité, portée et limites. Prat Organ Soins. 2009;40(3):213–23.CrossRef
27.
go back to reference Koopmanschap MA, Rutten FFH, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14:171–89.CrossRefPubMed Koopmanschap MA, Rutten FFH, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14:171–89.CrossRefPubMed
30.
go back to reference Sultan-Taieb H, Tessier P, Bejean S. Capital humain et coûts de friction. Quels critères de choix pour l’évaluation des pertes de production? Rev Économique. 2009;60:293–306.CrossRef Sultan-Taieb H, Tessier P, Bejean S. Capital humain et coûts de friction. Quels critères de choix pour l’évaluation des pertes de production? Rev Économique. 2009;60:293–306.CrossRef
34.
go back to reference Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2012;18(3):268–81. Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2012;18(3):268–81.
35.
go back to reference Team RC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012. [Internet]. ISBN 3-900051-07-0; 2014. https://www.r-project.org/. Accessed 12 Oct 2015. Team RC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012. [Internet]. ISBN 3-900051-07-0; 2014. https://​www.​r-project.​org/​. Accessed 12 Oct 2015.
37.
go back to reference Jusot F. Les inégalités de recours aux soins: bilan et évolution. Rev DÉpidémiologie Santé Publique. 2013;61:S163–9.CrossRef Jusot F. Les inégalités de recours aux soins: bilan et évolution. Rev DÉpidémiologie Santé Publique. 2013;61:S163–9.CrossRef
39.
go back to reference Pauly MV, Nicholson S, Xu J, Polsky D, Danzon PM, Murray JF, et al. A general model of the impact of absenteeism on employers and employees. Health Econ. 2002;11(3):221–31.CrossRefPubMed Pauly MV, Nicholson S, Xu J, Polsky D, Danzon PM, Murray JF, et al. A general model of the impact of absenteeism on employers and employees. Health Econ. 2002;11(3):221–31.CrossRefPubMed
41.
go back to reference Christiaens TCM, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002;52(482):729–34.PubMedPubMedCentral Christiaens TCM, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002;52(482):729–34.PubMedPubMedCentral
42.
go back to reference Elkharrat D, Brun-Ney D, Cordier B, Goldstein F, Péan Y, Sanson-Le-Pors MJ, et al. Prescriptions d’antibiotiques dans 34 services d’accueil et de traitement des urgences français. Médecine Mal Infect. 2003;33(2):70–7.CrossRef Elkharrat D, Brun-Ney D, Cordier B, Goldstein F, Péan Y, Sanson-Le-Pors MJ, et al. Prescriptions d’antibiotiques dans 34 services d’accueil et de traitement des urgences français. Médecine Mal Infect. 2003;33(2):70–7.CrossRef
44.
go back to reference Ciani O, Grassi D, Tarricone R. An economic perspective on urinary tract infection: the “costs of resignation.”. Clin Drug Investig. 2013;33(4):255–61.CrossRefPubMed Ciani O, Grassi D, Tarricone R. An economic perspective on urinary tract infection: the “costs of resignation.”. Clin Drug Investig. 2013;33(4):255–61.CrossRefPubMed
45.
go back to reference Turner D, Little P, Raftery J, Turner S, Smith H, Rumsby K, et al. Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial. BMJ. 2010;340:c346.CrossRefPubMedPubMedCentral Turner D, Little P, Raftery J, Turner S, Smith H, Rumsby K, et al. Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial. BMJ. 2010;340:c346.CrossRefPubMedPubMedCentral
47.
49.
go back to reference Fenwick EA, Briggs AH, Hawke CI. Management of urinary tract infection in general practice: a cost-effectiveness analysis. Br J Gen Pract J R Coll Gen Pract. 2000;50(457):635–9. Fenwick EA, Briggs AH, Hawke CI. Management of urinary tract infection in general practice: a cost-effectiveness analysis. Br J Gen Pract J R Coll Gen Pract. 2000;50(457):635–9.
50.
go back to reference Parienti JJ, Lucet JC, Lefort A, Armand-Lefèvre L, Wolff M, Caron F, et al. Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance. Am J Infect Control. 2015;43(9):e53–9. Parienti JJ, Lucet JC, Lefort A, Armand-Lefèvre L, Wolff M, Caron F, et al. Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance. Am J Infect Control. 2015;43(9):e53–9.
51.
go back to reference Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care. 2007;25(1):49–57.CrossRefPubMedPubMedCentral Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care. 2007;25(1):49–57.CrossRefPubMedPubMedCentral
52.
go back to reference Medina-Bombardó D, Seguí-Díaz M, Roca-Fusalba C, Llobera J, Dysuria team. What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women? Fam Pract. 2003;20(2):103–7.CrossRefPubMed Medina-Bombardó D, Seguí-Díaz M, Roca-Fusalba C, Llobera J, Dysuria team. What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women? Fam Pract. 2003;20(2):103–7.CrossRefPubMed
53.
go back to reference Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287(20):2701–10.CrossRefPubMed Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287(20):2701–10.CrossRefPubMed
54.
go back to reference Conclusions of the European Union Conference on “The microbial threat”, 9–10 September 1998. The Copenhagen Recommendation. Ministry of Health Ministry of Food, Agriculture and Fisheries. Vet Res. 1999 Feb;30(1):119–22. Conclusions of the European Union Conference on “The microbial threat”, 9–10 September 1998. The Copenhagen Recommendation. Ministry of Health Ministry of Food, Agriculture and Fisheries. Vet Res. 1999 Feb;30(1):119–22.
55.
go back to reference Haab F, Costa P, Colau J-C, Gérard A, Liard F, Bohbot J-M, et al. Les infections urinaires de la femme en médecine générale: résultats d’un observatoire réalisé auprès de 7916 patientes. Presse Med. 2006;35(9, Part 1):1235–40.CrossRefPubMed Haab F, Costa P, Colau J-C, Gérard A, Liard F, Bohbot J-M, et al. Les infections urinaires de la femme en médecine générale: résultats d’un observatoire réalisé auprès de 7916 patientes. Presse Med. 2006;35(9, Part 1):1235–40.CrossRefPubMed
Metadata
Title
The economic burden of urinary tract infections in women visiting general practices in France: a cross-sectional survey
Authors
M. François
T. Hanslik
B. Dervaux
Y. Le Strat
C. Souty
S. Vaux
S. Maugat
C. Rondet
M. Sarazin
B. Heym
B. Coignard
L. Rossignol
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1620-2

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