Affiliation:
1. Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA
2. Division of Urologic Surgery Washington University School of Medicine St. Louis Missouri USA
3. Simmons Comprehensive Cancer Center Biostatistics, Southwestern Medical Center, University of Texas Dallas Texas USA
4. Department of Urology The University of Alabama at Birmingham Birmingham Alabama USA
Abstract
AbstractIntroductionTo quantify and compare recurrent urinary tract infection costs between 1 year before and 1 year after electrofulguration.MethodsFollowing IRB approval, a well‐characterized cohort of non‐neurogenic women with >3 symptomatic urinary tract infections (UTIs)/year, a negative upper and lower urinary tract evaluation, and inflammatory bladder lesions (cystitis) on office cystoscopy who underwent fulguration of these lesions was analyzed. Cost of visits, imaging, labs, and medications were summed for 1‐year pre‐ and post‐fulguration using the Medicare Physician Fee Schedule, local pharmacy pricing, and institutional expenses. Before fulguration, all patients underwent clinic visit, noninvasive flow study, and flexible cystoscopy, and post‐fulguration, 6‐week follow‐up visit and 6‐month cystoscopy.ResultsNinety‐three women met study criteria (mean age 64), with 100% 1‐year follow‐up. Before fulguration, 73% of patients used daily antibiotic suppression, 6% self‐start antibiotics, and 5% postcoital prophylaxis. Some also used vaginal estrogens (17%), urinary analgesics (13%), and cranberry or d‐mannose supplements (7%). At 1 year post‐fulguration, 82% had 0–1 infections and no cystoscopy evidence of cystitis, while 14% required additional fulguration for new cystitis sites and recurrent infections. Patients had on average 0.7 infections in the 1‐year post‐fulguration, which was significantly lower than pre‐fulguration (p < 0.05). Mean 1‐year pre‐fulguration cost was $1328 (median $1071, range $291–$5564). Mean 1‐year post‐fulguration cost was $617 (median $467, range $275–$4580). On average, post‐fulguration costs were $710 lower than pre‐EF (p < 0.05).ConclusionFor women with antibiotic‐refractory recurrent urinary tract infections and cystoscopy evidence of cystitis, fulguration was associated with a significant reduction in UTI‐related costs in the 1‐year post‐fulguration.