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A Cost-effectiveness Analysis of Screening and Advocating Empiric Therapy for Asymptomatic Bacteriuria in Patient Attending Urogynaecology Clinic in Hospital Kuala Lumpur

Aznizasuriati B, Nurul Khairiyah K, Ng PY, Ravindran JUrogynaecology Unit, Obstetrics and Gynaecology Department, Kuala Lumpur Hospital, 50586, Jalan Pahang, Malaysia

Objectives

Introduction

Urinary tract infections (UTIs) are among the most common health problems in obstetrics and gynaecology patients.

Despite broad spectrum of presentation and complication ranging from asymptomatic bacteriuria to life threatening sepsis secondary to acute pyelonephritis, the diagnosis and treatment is usually straightforward.

Pelvic Organ Prolpase patients make up the most population of urogynaecology unit attendances and recurent UTIs are among the main presentation during their visits.

Being a tertiary referral unit which offer specialised expertise in prolapse surgery, considerable amount of patient may require surgical intervention and therefore healing process works best without any infection on board.

Early detection and treatment of UTIs may help to alleviate the economic burden on treating complication of UTIs.

Objective of This Study

This study aims :

1)to test the cost-effectiveness of Urine FEME compared with urine culture and sensitivity for screening of urinary tract infections (UTI) and 2)to compare the cost-effectiveness for advocating treatment based on the sensitivity analysis.

Methods

Study Design

Retrospective record review

Study Location

Urogynaecology Unit, Obstetrics and Gynaecology Department, Hospital Kuala Lumpur

Study Duration

1 year period from 1st January 2011 to 31st December 2011

Reference and Source Population

All patient attended Urogynaecology Unit Hospital Kuala Lumpur for urogynaecology consultation within the study period.

Sampling Method and Study Participant

Convenience sampling of 883 female patients who attended urogynaecology clinic during a 1-year period.

Data Collection

Urine FEME looking into leucocyte was used as a screening test for UTI while urine cultures were taken as an outcome.

Cost estimates were based on a local pharmacy and laboratory survey.

Nitrofurantoin is the antibiotic use in comparing the treatment cost.

Sensitivity analyses were performed and cost estimates calculated.

Results

Out of 883 patients screened, 118 (13.3%) had a significant UTI from urine culture.

Only 66 of the 118 patients were leucocyte positive on Urine FEME result.

Urine FEME has sensitivity of 55%, specificity of 94%, positive predictive value (PPV) of 59 % and negative predictive value (NPV) of 93%.

The cost of antibiotic use in treating UTI based on UFEME only is RM 9,324.00 compared to RM 5,544.00 after confirmation with positive urine culture.

However, cost of repeating urine culture before starting on empiric therapy in patient with positive leucocyte is higher at RM 13,320.00.

Conclusions

References

Negative urine FEME rules out asymptomatic bacteriuria and results in cost saving for further testing.

Advocating empiric treatment based on urine FEME is cost-effective for asymptomatic bacteria.

However, in patient with symptoms of UTI, urine Culture should be considered to save cost instead of urine FEME in urogynaecology clinic setting.

This is due to the fact that pelvic organ prolapsed patient made the most population in urogynaecology unit attendance and they are the populatian that were at risk to have recurrent UTI.

OPTIONALLOGO HERE

OPTIONALLOGO HERE

1. Bachman, J. W., R. H. Heise, et al. (1993). "A study of various tests to detect asymptomatic urinary tract infections in an obstetric population." JAMA 270(16): 1971-4.

2. Zaman Z, Borremans A, Verhaegen J, Verbist L, Blanckaert N, et al. (1998). “Disappointing dipstick screening for urinary tract infection in hospital inpatients.” . J Clin Pathol 51(6):471-2.

3. Wong HF, Lee LC, Han HC, et al (2008). “Cost-effective screening for urinary tract infections in urogynaecological patients.” Int Urogynecol J Pelvic Floor Dysfunct.19(5):671-6.

4. Rouse DJ, Andrews WW, Goldenberg RL, Owen J, et al. (1995). “Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis.” Obstet Gynecol. 86(1):119-23.

5. Preston A, O'Donnell T, Phillips CA, et al. (1999). : Screening for urinary tract infections in a gynaecological setting: validity and cost-effectiveness of reagent strips.” Br J Biomed Sci.56(4):253-7.

Objectives Methods Results Conclusions/Reference