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Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial

BMJ 2010; 340 doi: (Published 05 February 2010) Cite this as: BMJ 2010;340:c346
  1. David Turner, principal research fellow in health economics1,
  2. Paul Little, professor of primary care research2,
  3. James Raftery, professor, director of NETSCC and Wessex Institute1,
  4. Sheila Turner, senior research fellow1,
  5. Helen Smith, chair of primary care3,
  6. Kate Rumsby, research programme manager, Wessex Research Practices Collaboration2,
  7. Mark Mullee, director of the Research Design Service South Central and senior lecturer in medical statistics2,
  8. on behalf of the UTIS group
  1. 1Wessex Institute, University of Southampton, Alpha House, Southampton Science Park, Chilworth, Southampton SO16 7NS
  2. 2Community Clinical Sciences Division, Southampton University, Southampton SO16 6ST
  3. 3Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton
  1. Correspondence to: D Turner dturner{at}
  • Accepted 18 December 2009


Objective To assess the cost effectiveness of different management strategies for urinary tract infections.

Design Cost effectiveness analysis alongside a randomised controlled trial with a one month follow-up.

Setting Primary care.

Participants 309 non-pregnant adult women aged 18-70 presenting with suspected urinary tract infection.

Interventions Patients were randomised to five basic management approaches: empirical antibiotics, empirical delayed (by 48 hours) antibiotics, or targeted antibiotics based on either a high symptom score (two or more of urine cloudiness, smell, nocturia, dysuria), dipstick results (nitrite or leucocytes and blood), or receipt of a positive result on midstream urine analysis.

Main outcome measure Duration of symptoms and cost of care.

Results Management with targeted antibiotics with midstream urine analysis was more costly over the period of one month. Costs for the midstream urine analysis and dipstick management groups were £37 and £35, respectively; these compared with £31 for immediate antibiotics. Cost effectiveness acceptability curves suggested that if avoiding a day of moderately bad symptoms was valued at less than £10, then immediate antibiotics is likely to be the most cost effective strategy. For values over £10, targeted antibiotics with dipstick testing becomes the most cost effective strategy, though because of the uncertainty we can never be more than 70% certain that this strategy truly is the most cost effective.

Conclusion Dipstick testing with targeted antibiotics is likely to be cost effective if the value of saving a day of moderately bad symptoms is £10 or more, but caution is required given the considerable uncertainty surrounding the estimates.


  • We thank the practitioners for their time and Bayer for provision of the 8SG strips.

  • Contributors: PL had the original ideas for the study. ST ran the clinical trial on a day to day basis. KR managed the database. DT carried out the economic analysis in consultation with JR, PL, and MM. PL and HS contributed clinical knowledge. MM advised on statistical matters. All authors contributed to writing the paper. DT is guarantor.

  • Funding: This study was funded by the Health Technology Programme of UK NHS Research and Development.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare (1) no support from any company for the submitted work; (2) no relationships with any companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: This study was approved by the South West MReC ethical committee and informed consent was given by all patients.

  • Data sharing: No additional data available.

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