Activity impairment, health-related quality of life, productivity, and self-reported resource use and associated costs of uncomplicated urinary tract infection among women in the United States

• Published in: PloS one Vol. 18; no. 2; p. e0277728
• Main Authors: Thompson, Jeffrey, Marijam, Alen, Mitrani-Gold, Fanny S, Wright, Jonathon, Joshi, Ashish V
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.02.2023; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Age; Ambulatory care; Antibiotics; Antimicrobial agents; Biology and Life Sciences; Care and treatment; Coronaviruses; Cost of Illness; Costs; COVID-19; COVID-19 - epidemiology; Cross-Sectional Studies; E coli; Employment; Ethnicity; Expenditures; Female; Generalized linear models; Health aspects; Health Surveys; Humans; Impairment; Infections; Labor productivity; Medicine and Health Sciences; Multivariable control; Patient outcomes; People and places; Population; Primary care; Productivity; Quality of Life; Questionnaires; Regression analysis; Self Report; Sexual behavior; Sexual intercourse; Social Sciences; Surveys; United States - epidemiology; Urinary tract; Urinary tract diseases; Urinary tract infections; Urogenital system; Wellness; Women; Womens health; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0277728

Uncomplicated urinary tract infections (uUTIs) are among the most common infections in the US. Only a few studies, however, describe the impact of uUTIs from the patient perspective. A cross-sectional online survey of US women aged ≥18 years was performed assessing uUTI burden regarding activity impairment, health-related quality of life (HRQoL), workplace productivity, healthcare resource use (HRU), and costs. Participants who self-reported a uUTI in the prior 60 days treated with ≥1 oral antibiotic were included. Activity impairment was assessed with the Activity Impairment Assessment scale. HRQoL was assessed using a modified Short Form 36 (SF-36). Direct costs were sum of out-of-pocket expenditures and monetized HRU; indirect costs were calculated using Work Productivity and Activity Impairment (WPAI). Participants were stratified by uUTI recurrence, number of prescribed antibiotics for recent uUTI and therapy appropriateness (1 first-line/1 second-line/multiple antibiotics). Multivariable regression analysis assessed the relationship between stratifications and outcomes while controlling for demographic/clinical characteristics. Propensity score matching was used to compare participants to a matched population from the 2020 National Health and Wellness Survey (NHWS), to control for any impact of COVID-19 on responses. Among 375 participants, impaired activities included sexual intercourse (66.9%), sleep (60.8%) and exercise (52.3%). HRQoL was worse (p<0.0001) than the NHWS population (46.4 vs. 51.3 [physical component score]; 40.0 vs. 46.9 [mental component score]; 0.63 vs. 0.72 [health utility index]). All included WPAI assessments were worse for uUTI cohort vs. NHWS (p<0.0001). Adjusted direct costs were higher for participants receiving 2 vs. 1 antibiotic ($2090 vs. $776; p<0.0001) and receiving multiple antibiotics vs. 1 first-line ($1642 vs. $875; p = 0.002). Recurrent uUTI was associated with increased activity impairment, worse HRQoL, and costs vs. non-recurrent. uUTIs were associated with increased activity impairment, worse productivity, and reduced HRQoL. Higher costs were found vs. a matched population.