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Randomized Controlled Trial
. 2014 Apr 4;9(4):e91939.
doi: 10.1371/journal.pone.0091939. eCollection 2014.

Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial

Judith E Bosmans  1 , Mariëlle A J Beerepoot  2 , Jan M Prins  2 , Gerben ter Riet  3 , Suzanne E Geerlings  2
Affiliations
Randomized Controlled Trial

Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial

Judith E Bosmans et al. PLoS One. .

Abstract

Background: Urinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs.

Objective: To evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) over a 12 month period in premenopausal women with recurrent UTIs.

Materials and methods: An economic evaluation was performed alongside a randomized trial. Primary outcome was the number of UTIs during 12 months. Secondary outcomes included satisfaction and quality of life. Healthcare utilization was measured using questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to evaluate the cost-effectiveness of the treatments.

Results: Cranberry prophylaxis was less effective than TMP-SMX prophylaxis, but the differences in clinical outcomes were not statistically significant. Costs after 12 months in the cranberry group were statistically significantly higher than in the TMP-SMX group (mean difference €249, 95% confidence interval 70 to 516). Cost-effectiveness planes and cost-effectiveness acceptability curves showed that cranberry prophylaxis to prevent UTIs is less effective and more expensive than (dominated by) TMP-SMX prophylaxis.

Conclusion: In premenopausal women with recurrent UTIs, cranberry prophylaxis is not cost-effective compared to TMP-SMX prophylaxis. However, it was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs. Moreover, although we based the dosage of cranberry extract on available evidence, this may not be the optimal dosage. Results may change when this optimal dosage is identified.

Trial registration: ISRCTN.org ISRCTN50717094.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow of participants through the trial.
The lack of efficacy was determined by the patients. Abbreviations: TMP-SMX, trimethoprim-sulfametoxazole.
Figure 2
Figure 2. Cost-effectiveness plane for number of urinary tract infections prevented during 12 months (cranberry prophylaxis vs TMP-SMX prophylaxis).
The black dot indicates the point estimate of the ICER (1.6 prevented UTIs less and €247 more costs in the cranberry group as compared to the TMP-SMX group) and the grey dots indicate the bootstrapped cost-effect pairs to reflect the uncertainty around the ICER. Abbreviations: ICER, Incremental Cost-Effectiveness Ratio; TMP-SMX, trimethoprim-sulfametoxazole; UTI, Urinary Tract Infection.
Figure 3
Figure 3. Cost-effectiveness acceptability curve for number of urinary tract infections prevented during 12 months (cranberry prophylaxis vs TMP-SMX prophylaxis).
Abbreviations: TMP-SMX, trimethoprim-sulfametoxazole; UTI, Urinary Tract Infection.
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