Rubin N, Foxman B
Department of Health Services Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan USA.
J Clin Epidemiol. 1996 Nov;49(11):1315-21. doi: 10.1016/s0895-4356(96)00218-1.
We use cost-effectiveness analysis to estimate the economic and health implications of approving the over-the-counter sale of oral antibiotics for treatment of urinary tract infection (UTI). We consider two alternatives for over-the-counter availability and examine the reduced economic cost from avoided doctors' visits, along with the potential additional costs associated with higher over-the-counter treatment prices or increased use due to greater access. We also consider important noneconomic costs such as reduced symptom days, restricted activity days, and growing resistance to antibiotics. Our analysis covers a 20-year time horizon to capture the long-term effects, from a societal perspective, of a policy decision to place UTI treatment over the counter today. In addition, we present sensitivity analyses to test the effects of the assumptions in our model. We estimate that the economic costs of placing UTI treatment over the counter outweigh the benefits, unless there is extensive patient education and a mechanism for allowing patients to properly self-diagnose to reduce markedly the number of doctors' visits, mistreated symptoms, and threat of resistance to antibiotics. Only if doctors' visits were reduced to 64.6% of current levels would the economic benefits of over-the-counter treatment begin to be realized. UTI is one of the most common complaints among women and accounts for a large number of doctor visits each year. However, the costs of over-the-counter distribution of UTI treatment, particularly those due to the risk of decreasing the time until standard treatments become ineffective due to bacterial resistance, outweigh the short-term gains of decreased symptom days and increased access to treatment.
我们采用成本效益分析来评估批准口服抗生素非处方销售用于治疗尿路感染（UTI）所带来的经济和健康影响。我们考虑了非处方销售的两种方案，并研究了因避免看医生而降低的经济成本，以及与非处方治疗价格上涨或因更容易获得导致使用增加相关的潜在额外成本。我们还考虑了重要的非经济成本，如症状天数减少、活动受限天数以及抗生素耐药性增加。我们的分析涵盖了20年的时间范围，从社会角度捕捉当前将UTI治疗设为非处方的政策决定所产生的长期影响。此外，我们进行了敏感性分析，以测试模型中假设的影响。我们估计，除非进行广泛的患者教育并建立一种机制，使患者能够正确自我诊断，从而显著减少看医生的次数、误诊症状以及抗生素耐药性威胁，否则将UTI治疗设为非处方的经济成本将超过收益。只有当看医生的次数减少到当前水平的64.6%时，非处方治疗的经济效益才会开始显现。UTI是女性中最常见的病症之一，每年导致大量的看医生次数。然而，UTI治疗非处方分发的成本，特别是由于细菌耐药性导致标准治疗失效时间缩短的风险所带来的成本，超过了症状天数减少和治疗可及性增加的短期收益。
