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Urology. 2019 Jun;128:47-54. doi: 10.1016/j.urology.2019.01.031. Epub 2019 Feb 20.

Financial Burden of Recurrent Urinary Tract Infections in Women: A Time-driven Activity-based Cost Analysis.

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Department of Urology, UT Southwestern Medical Center, Dallas, TX.
University of Maryland School of Medicine, Baltimore, MD. Electronic address:



To utilize Time-Driven Activity-Based Costing to quantify costs of managing recurrent urinary tract infections (RUTI) in women.


RUTI was defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A care-delivery value chain outlined RUTI management (visits, urine studies, and imaging) for acute UTI followed by a form of long-term prevention. Prevention strategies included conservative therapy (Cranberry tablets, d-mannose, or lactobacillus); Estrogen therapy if postmenopausal; Antibiotic use (self-start, postcoital, or continuous regimens); or intravenous antibiotics in case of drug-resistance or intolerance. Costs of each resource were largely obtained from the Medicare Physician Fee Schedule, GoodRx and local pharmacy pricing, and institutional expenses. The capacity cost rate was defined as cost of resources per minute of care. Individual costs were summed to estimate overall expense of initial RUTI workup and annual cost for each long-term prevention strategy.


Cost of acute RUTI workup ranged from $390 to $730. Acute antibiotics cost ranged from $10 for oral trimethoprim-sulfamethoxazole to $3970 for intravenous Ertapenem. Annually, mean cost of conservative therapy ranged from $50 for d-mannose to $1290 for vaginal estradiol ring, and antibiotic use for self-start $40, postcoital $60, and continuous $190. Capacity cost rate ranged from $0.003/min for urine culture to $80/min for estrogen ring.


Using Time-Driven Activity-Based Costing, costs of RUTI management were efficiently determined. This offers new perspectives for patient counseling and long-term decision making.

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