Cost-effectiveness of cranberry capsules to prevent urinary tract infection in long-term care facilities: economic evaluation with a randomized controlled trial - PubMed (original) (raw)

Cost-effectiveness of cranberry capsules to prevent urinary tract infection in long-term care facilities: economic evaluation with a randomized controlled trial

Wilbert B van den Hout et al. J Am Geriatr Soc. 2014 Jan.

Abstract

Objectives: To investigate whether the preventive use of cranberry capsules in long-term care facility (LTCF) residents is cost-effective depending on urinary tract infection (UTI) risk.

Design: Economic evaluation with a randomized controlled trial.

Setting: Long-term care facilities.

Participants: LTCF residents (N = 928, 703 female, median age 84), stratified according to UTI risk.

Measurements: UTI incidence (clinically or strictly defined), survival, quality of life, quality-adjusted life years (QALYs), and costs.

Results: In the weeks after a clinical UTI, participants showed a significant but moderate deterioration in quality of life, survival, care dependency, and costs. In high-UTI-risk participants, cranberry costs were estimated at €439 per year (1.00 euro = 1.37 U.S. dollar), which is €3,800 per prevented clinically defined UTI (95% confidence interval = €1,300-infinity). Using the strict UTI definition, the use of cranberry increased costs without preventing UTIs. Taking cranberry capsules had a 22% probability of being cost-effective compared with placebo (at a willingness to pay of €40,000 per QALY). In low-UTI-risk participants, use of cranberry capsules was only 3% likely to be cost-effective.

Conclusion: In high-UTI-risk residents, taking cranberry capsules may be effective in preventing UTIs but is not likely to be cost-effective in the investigated dosage, frequency, and setting. In low-UTI-risk LTCF residents, taking cranberry capsules twice daily is neither effective nor cost-effective.

PubMed Disclaimer

Figures

Figure 1

Figure 1

The state-transition model used in the economic evaluation. UTI = Urinary Tract Infection.

Figure 2

Figure 2

Cost-effectiveness acceptability curves, for high-urinary tract infection (UTI)-risk participants (the probability that cranberry use is more cost-effective than placebo, depending on how much one is willing to pay for a quality-adjusted life year (QALY), based on utility measured using the EQ-5D or the visual analog scale (VAS)).

Comment in

References

    1. Nicolle LE. Urinary tract infections in the elderly. Clin Geriatr Med. 2009;25:423–436. -PubMed
    1. Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Am J Med. 2002;113(Suppl 1A):5S–13S. -PubMed
    1. Ruben FL, Dearwater SR, Norden CW, et al. Clinical infections in the noninstitutionalized geriatric age group: Methods utilized and incidence of infections. The Pittsburgh Good Health Study. Am J Epidemiol. 1995;141:145–157. -PubMed
    1. Dwyer LL, Harris-Kojetin LD, Valverde RH, et al. Infections in long-term care populations in the United States. J Am Geriatr Soc. 2013;61:341–349. -PubMed
    1. Caljouw MA, van den Hout WB, Putter H, et al. Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons. A double-blind randomized placebo-controlled trial in long-term care facilities. J Am Geriatr Soc. 2014:103–110. -PMC -PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources