美国女性非复杂性尿路感染的活动障碍、健康相关生活质量、生产力以及自我报告的资源使用和相关成本。
Activity impairment, health-related quality of life, productivity, and self-reported resource use and associated costs of uncomplicated urinary tract infection among women in the United States.
机构信息
Cerner Enviza, Malvern, Pennsylvania, United States of America.
GSK, Collegeville, Pennsylvania, United States of America.
出版信息
PLoS One. 2023 Feb 1;18(2):e0277728. doi: 10.1371/journal.pone.0277728. eCollection 2023.
BACKGROUND
Uncomplicated urinary tract infections (uUTIs) are among the most common infections in the US. Only a few studies, however, describe the impact of uUTIs from the patient perspective.
METHODS
A cross-sectional online survey of US women aged ≥18 years was performed assessing uUTI burden regarding activity impairment, health-related quality of life (HRQoL), workplace productivity, healthcare resource use (HRU), and costs. Participants who self-reported a uUTI in the prior 60 days treated with ≥1 oral antibiotic were included. Activity impairment was assessed with the Activity Impairment Assessment scale. HRQoL was assessed using a modified Short Form 36 (SF-36). Direct costs were sum of out-of-pocket expenditures and monetized HRU; indirect costs were calculated using Work Productivity and Activity Impairment (WPAI). Participants were stratified by uUTI recurrence, number of prescribed antibiotics for recent uUTI and therapy appropriateness (1 first-line/1 second-line/multiple antibiotics). Multivariable regression analysis assessed the relationship between stratifications and outcomes while controlling for demographic/clinical characteristics. Propensity score matching was used to compare participants to a matched population from the 2020 National Health and Wellness Survey (NHWS), to control for any impact of COVID-19 on responses.
RESULTS
Among 375 participants, impaired activities included sexual intercourse (66.9%), sleep (60.8%) and exercise (52.3%). HRQoL was worse (p<0.0001) than the NHWS population (46.4 vs. 51.3 [physical component score]; 40.0 vs. 46.9 [mental component score]; 0.63 vs. 0.72 [health utility index]). All included WPAI assessments were worse for uUTI cohort vs. NHWS (p<0.0001). Adjusted direct costs were higher for participants receiving 2 vs. 1 antibiotic ($2090 vs. $776; p<0.0001) and receiving multiple antibiotics vs. 1 first-line ($1642 vs. $875; p = 0.002). Recurrent uUTI was associated with increased activity impairment, worse HRQoL, and costs vs. non-recurrent.
CONCLUSIONS
uUTIs were associated with increased activity impairment, worse productivity, and reduced HRQoL. Higher costs were found vs. a matched population.
背景
在美国，单纯性尿路感染（uUTI）是最常见的感染之一。然而，仅有少数研究从患者角度描述 uUTI 的影响。
方法
对年龄≥18 岁的美国女性进行了一项横断面在线调查，评估了 uUTI 对活动障碍、健康相关生活质量（HRQoL）、工作场所生产力、医疗资源使用（HRU）和成本的影响。参与者在过去 60 天内自我报告患有 uUTI，并接受了≥1 种口服抗生素治疗。活动障碍通过活动障碍评估量表进行评估。HRQoL 使用改良的 36 项简短健康调查（SF-36）进行评估。直接成本是自付支出和货币化 HRU 的总和；间接成本使用工作生产力和活动障碍（WPAI）计算。根据 uUTI 复发、最近 uUTI 处方抗生素数量和治疗适宜性（1 线/1 线/多种抗生素）对参与者进行分层。多变量回归分析评估了分层与结果之间的关系，同时控制了人口统计学/临床特征。使用倾向评分匹配将参与者与 2020 年全国健康和健康调查（NHWS）的匹配人群进行比较，以控制 COVID-19 对反应的任何影响。
结果
在 375 名参与者中，受影响的活动包括性行为（66.9%）、睡眠（60.8%）和运动（52.3%）。HRQoL 明显差于 NHWS 人群（46.4 比 51.3[物理成分评分]；40.0 比 46.9[心理成分评分]；0.63 比 0.72[健康效用指数]）。与 NHWS 人群相比，所有包含的 WPAI 评估结果均较差（均<0.0001）。接受 2 种抗生素治疗的参与者比接受 1 种抗生素治疗的参与者（2090 美元比 776 美元；p<0.0001）和接受多种抗生素治疗的参与者比接受 1 种一线抗生素治疗的参与者（1642 美元比 1642 美元；p=0.002）的直接调整后成本更高。与非复发性 uUTI 相比，复发性 uUTI 与活动障碍增加、HRQoL 恶化和成本增加相关。
结论
uUTI 与活动障碍增加、生产力下降和 HRQoL 降低有关。与匹配人群相比，发现成本更高。
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