Cost effectiveness model comparing trimethoprim sulfamethoxazole and ciprofloxacin for the treatment of chronic bacterial prostatitis

Objectives: Antibiotics are the mainstay for the treatment of men with bacterial prostatitis. Despite numerous treatment strategies involving various types, dosages and duration of antibiotics, no uniform standard has been widely adapted. Moreover, the economic burden of these therapies has been heretofore poorly described. The purpose of this study was to compare the cost effectiveness of various antibiotic treatment regimens for chronic bacterial prostatitis. Methods: After reviewing the literature, we constructed a model that compared 90 days of double strength trimethoprim-sulfamethoxazole and 14, 28 and 60 days of ciprofloxacin 500 mg. Parameters examined included initial cure rates, relapse rates, total cure rates, pharmaceutical costs, and total cost of treatment. Using a spreadsheet Markov model, we applied cure rates and relapse rates to a hypothetical cohort of 100 men with culture positive chronic bacterial prostatitis. We then calculated cost of medications and total healthcare costs for the various drug regimens. Results: Twice daily ciprofloxacin @ 500 mg for 28 days proved to be the most cost effective treatment for chronic bacterial prostatitis. Yet, after sensitivity analysis, only twice daily ciprofloxacin @ 500 mg for 60 days demonstrated consistent benefit over trimethoprim-sulfamethoxazole but at a substantially increased cost. Conclusions: Our model implies that ciprofloxacin 500 mg twice daily for 28 days appears to be the most cost effective treatment for chronic bacterial prostatitis. Given the limitations of this type of modeling, long term, prospective, comparative trials will provide the most definitive method of evaluating optimal therapy for chronic bacterial prostatitis.