OBJECTIVES

: This health technology assessment (HTA) evaluates the use of phytotherapeutics (PT) for the treatment and prevention of uncomplicated recurrent urocystitis in women. The assessment of economic, ethical, social, organisational and legal aspects is focused on the German context.

METHODS

: The HTA follows the current method manual of the German Institute for Quality and Efficiency in Health Care (IQWiG). A systematic literature search was done in MEDLINE, Embase, Cochrane Databases and HTA Database for the efficacy domain and cost-effectiveness, a focused literature search and hand search for the other domains. Meta-analyses were conducted where possible. Five patients were involved through personal interviews.

RESULTS

: We identified 16 RCTs, the majority of which investigated products containing cranberry. Our meta-analysis of 6 studies shows a significant advantage of cranberry-containing products compared with placebo regarding the prevention of recurrences. However, the studies are mostly of low methodological quality and very heterogeneous regarding study design and studied interventions. Evidence from 2 studies suggests that cranberry-containing products prevent recurrences less effectively than antibiotics. The identified economic studies suggest that cranberry prophylaxis might incur higher overall costs than antibiotic prophylaxis, but emphasise that the potential costs of emerging antimicrobial resistances could not be estimated. Evidence on PTs other than cranberry is very sparse, few products have been studied in RCTs. PT products intended for the treatment of urocystitis are widely available in Germany but their costs are largely borne by the patients.

CONCLUSIONS

: There is limited evidence that cranberry-containing products reduce the frequency of recurrences more effectively than placebo but less effectively than antibiotics. Further research is needed to generate evidence regarding other PTs, to sustain more certain conclusions about cranberry-containing products (including their optimal preparation and dosage) and to incorporate costs of emerging antimicrobial resistances.