Management of Childhood Urinary Tract Infections: An Economic Modeling Study

• Published in: Value in health Vol. 12; no. 4; pp. 466 - 472
• Main Authors: Harmsen, Mirjam, MSc, Adang, Eddy M.M., PhD, Wolters, René J., MD, PhD, van der Wouden, Johannes C., PhD, Grol, Richard P.T.M., PhD, Wensing, Michel, PhD
• Format: Journal Article
• Language: English
• Published: Malden, USA Elsevier Inc 01.06.2009; Blackwell Publishing Inc
• Subjects: Adolescent; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Child; Child Welfare; Child, Preschool; Childhood; children; Confidence Intervals; Cost effectiveness; Cost-Benefit Analysis; economic analysis; Female; Glomerular Filtration Rate; Health costs; Humans; Infant; Infant, Newborn; Internal Medicine; Kidney Diseases - prevention & control; literature review; Male; Markov Chains; Models, Economic; Monte Carlo Method; Netherlands - epidemiology; Probability; Quality adjusted life years; Quality of Life; renal failure; Risk Factors; Urinary tract infections; Urinary Tract Infections - diagnosis; Urinary Tract Infections - drug therapy; Urinary Tract Infections - economics; Urinary Tract Infections - mortality; Netherlands; renal failure; literature review; children; economic analysis; urinary tract infections
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1111/j.1524-4733.2008.00477.x

Abstract Childhood urinary tract infections (UTIs) can lead to renal scarring and ultimately to terminal renal failure, which has a high impact on quality of life, survival, and health-care costs. Variation in the treatment of UTIs between practices is high. Objective To assess the cost-effectiveness of a maximum care model for UTIs in children, implying more testing and antibiotic treatment, compared with current practice in primary care in The Netherlands. Methods We performed a probabilistic modeling study using Markov models. Figures used in the model were derived from a systematic review of the research literature. Multidimensional Monte Carlo simulation was used for the probabilistic analyses. Results Maximum care gained 0.00102 (males) and 0.00219 (girls) QALYs (quality-adjusted life-years) and saved €42.70 (boys) and €77.81 (girls) in 30 years compared with current care, and was thus dominant. Net monetary benefit of maximum care ranged from €20 to €200 for a willingness to pay for a QALY ranging from €0 to €80,000, respectively. Maximum care was also dominant over improved current care, although less dominant than to current care. Conclusions This study suggested that maximum care for childhood UTI was dominant in the long run to current care, meaning that it delivered more quality of life at lower costs. Nevertheless, making firm conclusions is not possible, given the limitations of the input data.