The weighted average cost-per-patient for treating uUTI in Ontario was also estimated based on 2 scenarios: with and without fosfomycin.
Figure 6 compares the cost-per-patient for treating uUTI with a fluoroquinolone, sulfonamide, nitrofurantoin, or fosfomycin with various probabilities of progression to pyelonephritis.
Figure 7 compares the cost-per-patient for treating uUTI with one of the 4 antimicrobial treatments with the probability of hospitalization due to pyelonephritis.
Figure 8 compares the expected cost-per-patient for the treatment of a uUTI with a fluoroquinolone, sulfonamide, nitrofurantoin, or fosfomycin with the prevalence of TMPSMX-resistant E.
The major difference in the results of this sensitivity analysis was that the cost of nitrofurantoins was the third highest contributor to the potential variation in cost-per-patient--meaning that the cost of nitrofurantoins has a great influence on the cost of treating patients with uUTI covered by the ODB.
Although there is limited experience with fosfomycin for treating uUTI in Canada , it has been used successfully for decades in other countries [19, 20].
Resistance rates for ciprofloxacin and TMP-SMX (INESSS first-line recommendations for treatment of uUTI) were much lower a decade ago than they are now.
coli strains causing uUTI vary considerably across regions and can be well beyond the resistance threshold for certain antibiotics, the IDSA/ESCMID guidelines note that a specific treatment recommendation may not be universally suitable [5, 46].
This analysis revealed that the cost-per-patient for treating uUTI in Ontario is similar for all 4 antibiotics, ranging from $96.19 for sulfonamides to $105.12 for fosfomycin.
This model has been constructed to specifically address the empirical treatment of uUTI in women older than 18 years of age.
Additionally, head-to-head studies of antibiotic efficacy and safety in current uUTI patient populations would provide much needed data for developing accurate probabilities of treatment success/failure.
Fosfomycin in addition to being a safe and effective agent to treat uUTI has a low resistance profile, offers a single-dose treatment regimen, and is comparable in cost to other reimbursed antibiotics.