Cost-effectiveness analysis of rapid antimicrobial susceptibility testing as a point of care for patients with uncomplicated urinary tract infection in Japan

BACKGROUND: Empirical antibiotic therapy for patients with urinary tract infections (UTIs) has contributed to the rise of overuse or use of inappropriate antibiotics, which is a significant public health concern. The introduction of point-of-care diagnostic tests (POCTs) for the rapid determination of antimicrobial susceptibility is predicted to help reduce unnecessary broad-spectrum antibiotic use and produce actionable information for an approach to antibiotic stewardship. AIMS: To evaluate the cost-effectiveness of UTI diagnostic and treatment strategies, including a POCT in Japan. METHODS: A decision tree model was constructed from a healthcare payer perspective to compare three diagnostic and treatment strategies for patients with uncomplicated UTIs visiting community clinics or hospital outpatient settings in Japan: (1) a POCT-guided strategy; (2) empirical broad-spectrum antibiotic treatment alone; and (3) empirical broad-spectrum antibiotic treatment with concurrent conventional culture. The study population was stratified into patients with cystitis and those with pyelonephritis. The time horizon was set at 30 days for cystitis and 60 days for pyelonephritis. RESULTS: For patients with cystitis, the incremental cost-effectiveness ratio (ICER) for the POCT strategy was JPY 10,787,224 per quality-adjusted life year (QALY) gained compared with broad-spectrum antibiotic agents only, and JPY 1,552,864/QALY compared with broad-spectrum antibiotic agents plus culture. For patients with pyelonephritis, the ICERs for the POCT strategy were JPY 2,362,912/QALY versus broad-spectrum antibiotic agents only, and JPY 222,752/QALY versus broad-spectrum antibiotic agents plus culture. CONCLUSIONS: Compared with the broad-spectrum antibiotic agents plus culture strategy, which is common practice in Japan, the POCT strategy demonstrated potential cost-effectiveness for patients with cystitis and pyelonephritis. These results suggest that introducing POCTs for patients with UTIs in Japan may be a cost-effective approach.