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The diagnosis of urinary tract infection in young children (DUTY) study clinical rule: economic evaluation

Hollingworth, William, Busby, John, Butler, Christopher C., O'Brien, Kathryn, Sterne, Jonathan A.C., Hood, Kerenza, Little, Paul, Lawton, Michael, Birnie, Kate, Thomas-Jones, Emma, Harman, Kim and Hay, Alastair D. 2017. The diagnosis of urinary tract infection in young children (DUTY) study clinical rule: economic evaluation. Value in Health 20 (4) , pp. 556-566. 10.1016/j.jval.2017.01.003

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Abstract

Objective To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care. Methods Decision analytic model synthesising data from a multicentre, prospective cohort study (DUTY) and the wider literature to estimate the short-term and lifetime costs and healthcare outcomes (symptomatic days, recurrent UTI, quality adjusted life years) of eight diagnostic strategies. We compared GP clinical judgement with three strategies based on a ‘coefficient score’ combining seven symptoms and signs independently associated with UTI and four strategies based on weighted scores according to the presence/absence of five symptoms and signs. We compared dipstick testing versus laboratory culture in children at intermediate risk of UTI. Results Sampling, culture and antibiotic costs were lowest in high-specificity DUTY strategies (£1.22 and £1.08) compared to clinical judgement (£1.99). These strategies also approximately halved urine sampling (4.8% versus 9.1% in clinical judgement) without reducing sensitivity (58.2% versus 56.4%). Outcomes were very similar across all diagnostic strategies. High-specificity DUTY strategies were more cost-effective than clinical judgement in the short- (iNMB = £0.78 and £0.84) and long-term (iNMB =£2.31 and £2.50). Dipstick tests had poorer cost-effectiveness than laboratory culture in children at intermediate risk of UTI (iNMB = £-1.41). Conclusions Compared to GPs’ clinical judgement, high specificity clinical rules from the DUTY study could substantially reduce urine sampling, achieving lower costs and equivalent patient outcomes. Dipstick testing children for UTI is not cost-effective.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: antibacterial agents; diagnosis; economics; medical; pediatrics; urinary tract infections
Publisher: Elsevier
ISSN: 1098-3015
Funders: NIHR HTA
Date of First Compliant Deposit: 12 June 2017
Date of Acceptance: 22 February 2017
Last Modified: 26 May 2019 22:37
URI: http://orca.cf.ac.uk/id/eprint/101092

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