Wessex Institute, University of Southampton, Alpha House, Southampton Science Park, Chilworth, Southampton SO16 7NS.
BMJ. 2010 Feb 5;340:c346. doi: 10.1136/bmj.c346.
To assess the cost effectiveness of different management strategies for urinary tract infections.
Cost effectiveness analysis alongside a randomised controlled trial with a one month follow-up.
Primary care.
309 non-pregnant adult women aged 18-70 presenting with suspected urinary tract infection.
Patients were randomised to five basic management approaches: empirical antibiotics, empirical delayed (by 48 hours) antibiotics, or targeted antibiotics based on either a high symptom score (two or more of urine cloudiness, smell, nocturia, dysuria), dipstick results (nitrite or leucocytes and blood), or receipt of a positive result on midstream urine analysis.
Duration of symptoms and cost of care.
Management with targeted antibiotics with midstream urine analysis was more costly over the period of one month. Costs for the midstream urine analysis and dipstick management groups were pound37 and pound35, respectively; these compared with pound31 for immediate antibiotics. Cost effectiveness acceptability curves suggested that if avoiding a day of moderately bad symptoms was valued at less than pound10, then immediate antibiotics is likely to be the most cost effective strategy. For values over pound10, targeted antibiotics with dipstick testing becomes the most cost effective strategy, though because of the uncertainty we can never be more than 70% certain that this strategy truly is the most cost effective.
Dipstick testing with targeted antibiotics is likely to be cost effective if the value of saving a day of moderately bad symptoms is pound10 or more, but caution is required given the considerable uncertainty surrounding the estimates.
评估不同管理策略治疗尿路感染的成本效益。
与一项为期一个月随访的随机对照试验并行的成本效益分析。
初级保健。
309 名年龄在 18-70 岁之间、患有疑似尿路感染的非妊娠成年女性。
患者被随机分配到五种基本管理方法：经验性抗生素、延迟（48 小时后）抗生素、或基于高症状评分（尿液混浊、气味、夜尿、尿痛中有两项或以上）、尿试纸结果（亚硝酸盐或白细胞和红细胞）、或中段尿分析阳性结果的靶向抗生素。
症状持续时间和护理成本。
使用中段尿分析的靶向抗生素管理在一个月内的成本更高。中段尿分析和尿试纸管理组的成本分别为 37 英镑和 35 英镑；而立即使用抗生素的成本为 31 英镑。成本效益接受性曲线表明，如果避免一天中度不良症状的价值低于 10 英镑，那么立即使用抗生素可能是最具成本效益的策略。对于价值超过 10 英镑的情况，使用尿试纸进行靶向抗生素治疗成为最具成本效益的策略，但由于存在不确定性，我们永远不能有超过 70%的把握确定该策略确实是最具成本效益的。
如果节省一天中度不良症状的价值为 10 英镑或以上，那么使用尿试纸进行靶向抗生素治疗可能具有成本效益，但由于估计存在很大的不确定性，需要谨慎。
