The cost-effectiveness of placing urinary tract infection treatment over the counter

We use cost-effectiveness analysis to estimate the economic and health implications of approving the over-the-counter sale of oral antibiotics for treatment of urinary tract infection (UTI). We consider two alternatives for over-the-counter availability and examine the reduced economic cost from avoided doctors' visits, along with the potential additional costs associated with higher over-the-counter treatment prices or increased use due to greater access. We also consider important noneconomic costs such as reduced symptom days, restricted activity days, and growing resistance to antibiotics. Our analysis covers a 20-year time horizon to capture the long-term effects, from a societal perspective, of a policy decision to place UTI treatment over the counter today. In addition, we present sensitivity analyses to test the effects of the assumptions in our model. We estimate that the economic costs of placing UTI treatment over the counter outweigh the benefits, unless there is extensive patient education and a mechanism for allowing patients to properly self-diagnose to reduce markedly the number of doctors' visits, mistreated symptoms, and threat of resistance to antibiotics. Only if doctors' visits were reduced to 64.6% of current levels would the economic benefits of over-the-counter treatment begin to be realized. UTI is one of the most common complaints among women and accounts for a large number of doctor visits each year. However, the costs of over-the-counter distribution of UTI treatment, particularly those due to the risk of decreasing the time until standard treatments become ineffective due to bacterial resistance, outweigh the short-term gains of decreased symptom days and increased access to treatment.