Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

UPJ INSIGHT An Analysis of Topical Estrogen Therapy in Urinary Tract Infection Prevention Among Postmenopausal Women

By: Charlotte Goldman Houston, MD, Georgetown University, Washington, District of Columbia; William S. Azar, Georgetown University, Washington, District of Columbia; Sean Shenghsiu Huang, PhD, Georgetown University, Washington, District of Columbia; Rachel Rubin, MD, Georgetown University, Washington, District of Columbia; C. Scott Dorris, MLIS, AHIP, Dahlgren Medical Library, Georgetown University Medical Center, Washington, District of Columbia; Rachael Sussman, MD, Georgetown University, Washington, District of Columbia | Posted on: 18 Mar 2024

Houston CG, Azar WS, Huang SS, Rubin R, Dorris CS, Sussman R. A cost savings analysis of topical estrogen therapy in urinary tract infection prevention among postmenopausal women. Urol Pract. 2024;11(2):257-266.

Study Need and Importance

UTIs pose a significant health concern for geriatric patients. Recurrent infections are prevalent in postmenopausal women as pathogenic bacteria thrive in a low-estrogen
environment. Topical estrogen therapies have demonstrated a substantial benefit in preventing infections in this population. Given the economic burden of UTI in the United States, we sought to evaluate the costs associated with these topical estrogen therapies.

What We Found

Our research methodology involved conducting a systematic literature review to gather evidence on the efficacy of topical estrogen therapy in reducing UTIs. We also conducted a comprehensive review of Medicare spending on UTIs per beneficiary, considering the likelihood of complicated and resistant infections. By extrapolating the cost per UTI ($1222) and considering the reduction in infections, the potential savings range between $3670 and $5499 per beneficiary per year. Additionally, we examined the financial implications of topical estrogen therapies, incorporating the costs of the treatment itself. Considering both the therapy costs and the reduction in UTI spending, our findings indicate an overall cost savings of $1226 to $4888 annually per patient. Given the prevalence of UTI in this population, this has the potential for billions of dollars in Medicare savings each year.


This study is limited to evaluating direct cost savings associated with UTI reduction calculated using previously published Medicare spending and reported reduction in annual incidence of UTIs from studies of topical estrogen therapy.

Interpretation for Patient Care

These results highlight the potential for topical estrogen therapies to serve as a cost-conscious approach for alleviating the burden of UTIs in postmenopausal women. The significant savings identified through our analysis underscore the importance of implementing systemic efforts to make these therapies accessible and affordable for patients.