Bladder infection do herbal remedies help with recurrent bladder infection? : iQWiG reports - commission no. HT20-01
For 6 months of long-term preventive therapy with antibiotics, in contrast, patients incurred costs of (a maximum of) about €20 to €35 (at total costs of up to €130). According to cost effectiveness literature on cranberry prophylaxis (compared with placebo), the enhanced effectiveness with respect...
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| Format: | eBook |
| Language: | English |
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Köln, Germany
Institute for Quality and Efficiency in Health Care
24 February 2022, 2022
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| Edition: | Version 1.0 |
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| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | For 6 months of long-term preventive therapy with antibiotics, in contrast, patients incurred costs of (a maximum of) about €20 to €35 (at total costs of up to €130). According to cost effectiveness literature on cranberry prophylaxis (compared with placebo), the enhanced effectiveness with respect to recurrence prevention is juxtaposed by higher direct costs. Cranberry's lower effectiveness in recurrence prevention when compared with antibiotic prevention is paired with higher cost (than antibiotics), making cranberry prophylaxis the predominant alternative over antibiotics. However, this calculation ignored the potential costs of antibiotic resistance. Due to poor transferability and substantial deficiencies in quality and transparency, however, the identified health economic evaluations are of very limited use for assessing cost effectiveness in the present HTA report. Due to very limited data being available, it is impossible to assess whether the preventive use of other phytopreparations may be a good option No adverse events data are available for comparing a preparation made of lovage root, rosemary leaves, and common centaury herb in combination with antibiotics versus antibiotic monotherapy; no conclusion can be drawn on benefit. For all other comparisons investigated herein, the reported adverse events show no hint of greater or lesser harm from one of the investigated preparations in comparison with the respective comparator intervention. The transferability of the benefit assessment's results to Germany is limited by the fact that not all herbal preparations investigated in the benefit assessment correspond to commercial products available in Germany. More than half of the cranberry monopreparations and 2 of the preparations without cranberry (uva ursi leaves and birch as well as uva ursi leaves and dandelion) were either impossible to find, inadequately described, or no longer (if ever) available on the market. The assessment found a hint of benefit for a preparation made from uva ursi leaves and dandelion in comparison with placebo as well as a hint of added benefit (in combination with antibiotics) of a preparation made of lovage root, rosemary leaves, and common centaury herb versus antibiotic monotherapy for recurrence prevention. Very few data are available for the outcomes of health-related quality of life, development of complicated infections, specific symptoms, and mortality. For mortality and health-related quality of life, this results in no hint of benefit for cranberry preparations in comparison with placebo. For specific symptoms, there is no hint of benefit for a preparation made of lovage root, rosemary leaves, and common centaury herb in combination with antibiotics when compared with antibiotic monotherapy. No further conclusions on benefit can be drawn regarding these outcomes. Among the 34 plants (or part components) which had been predefined as being relevant for this HTA report, 9 were investigated in the included studies. Most studies examined preparations containing cranberry. This results in an indication of benefit for cranberry in comparison with placebo regarding the reduction of recurrence rate and a hint regarding the extension of the interval until the first recurrence. There is a hint of lesser benefit of cranberry regarding recurrence prevention when compared with antibiotics, specifically trimethoprim sulphamethoxazole. Aside from cranberry, isolated study results are available on preparations containing the following plants (or plant components): 1 preparation with horseradish root and nasturtium herb, 1 preparation with uva ursi leaves and birch, 1 preparation with uva ursi leaves and dandelion, and 1 preparation with lovage root, rosemary leaves, and common centaury herb. In any case, important factors influencing the cost effectiveness of cranberry prophylaxis in comparison with antibiotic prophylaxis were found to be effectiveness in recurrence prevention (and the associated cost savings), the cost of the preparations themselves, and potential cost savings achieved by preventing antibiotic resistance. The legal situation is complex because preparations made from the investigated plants (or plant components) may be marketed as either herbal medicinal products or dietary supplements. Unlike prescription drugs, dietary supplements do not require proof of efficacy, while herbal medicinal products do so only to a limited extent. For patients, very similar packaging often additionally complicates determining a preparation's product category. Herbal medicinal products are reimbursed by health insurance funds only in isolated cases, and dietary supplements are never reimbursed. No data are available on the use of cranberry preparations or other phytopreparations in the acute treatment of symptomatic episodes experienced by women with uncomplicated recurrent lower UTIs This aspect is relevant from an ethical and social perspective because many patients would like to use herbal medicinal products to treat lower UTIs, but they have to pay for them out of pocket. For society, potentially reducing antibiotic use via herbal medicinal products is a highly relevant aspect. Since current guidelines recommend antibiotics for the long-term prevention of lower UTIs only in exceptional cases, said societal aspect primarily concerns the acute treatment of lower UTIs. However, no study data are available on the efficacy of herbal medicinal products in the acute care of lower UTIs in women with recurrent uncomplicated lower UTIs. Further research is needed: High-quality studies providing detailed information on the investigated preparations' composition would allow making more definitive statements regarding the effectiveness and transferability of these conclusions to preparations available in Germany. RESEARCH QUESTION OF THE HTA REPORT: The aims of this investigation are to1. assess the benefit of treatment with herbal remedies (phytopreparations) in comparison with different or no treatment in adult patients (16 years and older) with uncomplicated, recurrent lower urinary tract infections (UTIs) regarding patient-relevant outcomes,2. determine the costs (intervention costs) and assess the cost effectiveness of phytopreparations in comparison with different or no treatment in adult patients (16 years and older) with uncomplicated recurrent lower UTIs and3. review ethical, social, legal, and organizational aspects associated with the medical intervention. CONCLUSION OF THE HTA REPORT: The benefit of phytopreparations in comparison with different or no treatment in adult women with uncomplicated recurrent lower UTIs was investigated by 15 studies meeting this health technology assessment (HTA) report's inclusion criteria. If appropriately disseminated, this information might help affected patients navigate through the very nontransparent market of herbal medicinal products and dietary supplements. Studies proving effectiveness are also a prerequisite for approval as prescription-only drugs and hence for general reimbursability. This approval, in turn, would give all affected patients easy access to (effective) PPs. Two currently ongoing studies (which both investigate cranberry preparations) might supply additional data relevant for the research question. CONCLUSION IN TERMS OF ADDRESSING THE CONCERNS OF THOSE PROPOSING THE TOPIC: The preventive use of cranberry preparations may be a good option for women with uncomplicated recurrent lower UTIs because such use is associated with an indication of benefit for relapse prevention in comparison with placebo, and the S3 guideline recommends preventive use of antibiotics only in exceptional cases. With regard to the determination of costs, the available studies and data placed the focus on long-term prevention. Among the investigated phytopreparations, the cost of 6 months of treatment with these foods or dietary supplements ranged from €60 to €270; these costs must be borne by the patients out of pocket. For other herbal medicinal products which were classified as pharmaceuticals by the LAUER-TAXE(r) pharmaceuticals database, costs equalled €110 to €300; some of these costs were covered by health insurance companies on a case-by-case basis. For "general preventive measures and non-antibiotic therapies" which, according to the S3 guideline, are to be exhausted before potentially initiating long-term preventive antibiotic treatment, prevention with phytopreparations therefore incurs potential semiannual costs to be paid by patients in the two-digit to low three-digit range. |
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| Item Description: | "IQWiG reports - No. 1300.". - "ThemenCheck Medizin.". - Translation of Chapters 1 to 9 of the HTA report HT20-01 Blasenentzündung: Helfen pflanzliche Mittel bei wiederkehrender Blasenentzündung? (Version 1.0; Status: 24 February 2022 [German original], 01 February 2023 [English translation]) |
| Physical Description: | 1 PDF file (77 pages) |