# Prevalence and economic evaluation of acute uncomplicated cystitis in women from Japan: a retrospective cohort study

## TL;DR

This study examines the prevalence and costs of acute uncomplicated cystitis in Japanese women, highlighting treatment failures and antibiotic use patterns.

## Contribution

The study provides new insights into the economic and epidemiological impact of AUC in Japan, including treatment failure rates and cost implications.

## Key findings

- The age-standardized prevalence of AUC in Japan decreased from 8.62% to 6.02% between 2016 and 2021.
- Treatment failure occurred in 5.24% of patients, with 45.48% of these cases involving fluoroquinolone use.
- The mean total AUC-related cost per patient was ¥14,905, with pharmacy costs averaging ¥1,059.

## Abstract

Although Japanese guidelines recommend fluoroquinolones (FQs) and cephalosporins for AUC (acute uncomplicated cystitis) treatment, the emergence of FQ-resistant uropathogens and inappropriate use of antibiotics may lead to treatment failure (TF), and increased healthcare costs. There is a need to understand the epidemiology, treatment patterns, and healthcare cost implications associated with AUC in Japan.

This retrospective cohort study used the Japanese Medical Database Centre database (1 October 2015–30 November 2021). Female patients (≥18 years) had an AUC diagnosis in the same month as ≥1 oral antibiotic prescription claim in the outpatient setting. The population was stratified into cohorts by TF status and history of AUC recurrence prior to index (pre-index recurrence). Baseline demographics were evaluated in the 12-month pre-index period and age standardized prevalence of AUC was calculated. Treatment patterns and AUC-related costs [2022 Japanese Yen (¥)], were reported for the post-index follow-up period.

Of 71 476 total patients, 62.46% were aged <50 years. Patients had evidence of TF (n = 3742; 5.24%) and pre-index recurrence (n = 3206; 4.49%). The age standardized prevalence of AUC (2016–2021) decreased from 8.62% to 6.02%, with up to 3.9 million women affected each year. A high proportion of patients with TF received FQs (45.48%) and third generation cephalosporins (43.37%). The mean total AUC-related costs were ¥14 905 and pharmacy costs were ¥1059 per patient, per index AUC episode.

Healthcare providers should consider the cost implications for patients with antibiotic TF or a history of AUC recurrence when selecting antibiotics for empiric treatment in Japan.