PATTERNS AND COSTS OF HEALTH CAREUTILIZATION BEFORE DURING AND AFTER EXPOSURE TO CRANBERRY FOR THEPREVENTION OF URINARY TRACT INFECTION IN WOMEN; RESULTS FROM ARANDOMIZED CONTROLLED CLINICAL TRIAL
L. STOTHERS1, M.LEVINE 1, J. BERKOWITZ 1, P. BROWN 2;
1Univ. of British Columbia, Vancouver, Canada,2British Columbia Inst. of Technology, Vancouver, Canada.
Introduction: Concerns have beenraised by the WHO regarding escalation of resistant bacterialinfections, including urinary tract infection (UTI), leading torenewed interest in a ‘prevention first’ approach. Health careutilization and associated costs for women consuming cranberry juicefor UTI prevention are not established.
Objective: Toexamine health care utilization patterns for women with a history ofurinary tract infection who had been exposed in a blinded randomizedtrial to cranberry over a period of one year.
Methods:Following a blinded RCT comparing placebo to low and medium dosecranberry juice for UTI prevention in community dwelling women with ahistory of recurrent UTI, clinical data for 123 of 263 randomizedwere linked to provincial medical services plan (MSP) data (singlepayer government run system). Health care utilization over a 3-yearperiod (1 yr prior, 1 yr during and 1 yr post RCT) was examined usingICD9 code 595 for cystitis, 589,590,593 for kidney and 788, 780, 999,789, 596, 791 for lower urinary tract symptoms. Administrativealgorithms for identifying UTIs were tested for accuracy by comparingeach algorithm to UTI data during the RCT and assessed forinter-rater reliability using weighted Kappa. All costs includingurinalysis (U/A) within 7 days and number of visits associated withUTI were tabulated for group comparisons including Anova.
Results:Using ICD 9 code 595 plus U/A within 7 days participants saw their GPfor UTI a mean 2.4,2.2 and 2.3 times in the year prior to study forplacebo, low and medium dose respectively. Following exposure visitswere lower across all 3 arms, with the greatest difference in the lowdoes group, which experienced 64% fewer visits post study. Pre RCThospital visits for UTI were seen a mean 2.8, 2.8 and 2.6 times peryear for placebo, low and medium dose. The greatest apparentreduction was in the low dose group, falling to a mean of 1visit/person/year. Cranberry exposure in the low dose group had thegreatest reduction in mean dollars paid to specialists/patient/yearbeing, compared to an increase in the placebo group post exposure(Anova 0.08). Dollars/patient/urologist in the year followingexposure was different between groups, with the greatest differenceseen in the low dose group, which fell to zero (Anova 0.08). In theyear following exposure to cranberry, UTI-related costs paid to labswas reduced by 54% and 52% in low and medium dose compared to 43%with placebo.
Conclusions: Exposure to low and medium dosesof cranberry juice for one year has the potential to reducespecialist and GP visits and associated costs among women with ahistory of recurrent UTI.