ANN ARBOR---Health consumers plagued by urinary tract infections (UTI) might be pleased by the convenience of over-the-counter availability for UTI antibiotic treatment. A cost-effectiveness analysis conducted by researchers at the University of Michigan School of Public Health, however, suggests that such a move would be risky business.
"Over-the-counter antibiotic treatment for UTI would not be cost-effective in the long run, according to our cost-effectiveness analysis, and it also would be highly risky from a public health perspective. Resistance to antibiotics would most probably increase over time, due to misdiagnosis by consumers, and leave them with fewer treatment options in the future," explained Betsy Foxman, associate professor of epidemiology. UTIs are generally self-limiting in otherwise healthy women who are experiencing no fever or back pain, Foxman added.
Foxman and her colleague, Nicole Rubin, a U-M graduate from the School of Public Health, now with the Lewin Group in Sausalito, Calif., report their analysis in the November issue of the Journal of Clinical Epidemiology. UTI antibiotic treatments are not currently available over the counter.
Urinary symptoms account for 6 million to 7 million doctor visits a year, making it one of the most common problems seen by primary care physicians.
"Of those, 3.6 million are actual, diagnosed cases," Rubin said. "Another 2.7 million are triggered by other conditions, such as chlamydia, vaginal yeast infection and genital herpes."
The cost-effectiveness analysis, which was based on a 20-year time horizon, included the costs of doctor visits and the costs of both over-the-counter and prescription medical treatments. It also assessed the benefits of reduced symptom days.
The U-M analysis found: if over-the-counter treatment were available in a pack that would include both a dipstick diagnostic test and antibiotics, the national costs for UTI-associated doctor visits would decline $31.4 million a year, from $157.1 million to $125.7 million. However, the benefits in reduced costs for doctor visits would be offset by an increase of $55.6 million in treatment costs, from the current $23.6 million a year for prescriptions to $79.1 million a year for the over-the-counter packs.
"Over a 20-year time horizon, discounted 5 percent annually for the declining value of the dollar, the additional treatment costs would amount to more than $300 million," Rubin said.
What about the costs in human discomfort and suffering?
"Earlier over-the-counter treatment would produce a reduction in the number of symptom days, ranging from 52.1 million days to 78.2 million days a year," Foxman said. "However, the reduced symptom days would be purchased at a significant social and health cost tomorrow in terms of antibiotic resistance," she stressed.
"As a society we must weigh the benefits of increased access to a treatment that reduces the impact of the disease in the individual consumer against the risks of shortening the time that these antibiotics remain effective. Antibiotic resistance can sweep geographic areas seemingly overnight."
More than 200 medications that were prescription-only just 10 years ago are now sold over the counter due to rising demand among consumers to have more control over their own health care. Among them were vaginal yeast infection antimycotics.
Sales rose 800 percent for yeast infection medications during the five years after the Food and Drug Administration approved over-the-counter access in 1990. The soaring sales suggest "overuse," according to the U-M researchers, and "physicians are consequently concerned about growing resistance to the yeast infection medications."
Easy access to over-the-counter UTI treatments would have another disturbing consequence for public health, according to Rubin. "Serious health conditions such as chlamydia and other sexually transmitted diseases would go undetected and untreated until more serious infection occurs."
"For all these reasons, we recommend against offering UTI antibiotics over-the-counter. Instead, to save costs, we suggest that less expensive practitioners, such as nurse practitioners or physician assistants, treat routine UTI cases," Foxman said. Also, for commonly recurring cases, physicians might consider installing a nurse telephone line to conduct a careful screening and reauthorize three-day prescriptions.
"These techniques would avoid making antibiotics available indiscriminately over-the-counter while helping to reduce health care costs," Rubin said.
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