Urinary tract infections (UTIs) are one of the most common bacterial infections of early childhood. The signs of UTI in young children are non-specific, so many children with unexplained fever require a urine sample to diagnose or exclude UTI. The problem is that collecting a urine sample from a young child is challenging. Different collection methods exist, but all have limitations. Non-invasive methods (urine bags, clean catch, voiding stimulation) can be time-consuming, unsuccessful or contaminated. Invasive methods (catheter or suprapubic needle aspiration) cause pain and distress to the child and require specialist expertise and equipment to perform. The cost effectiveness of each collection method is unknown.
This study aimed to determine the cost effectiveness of urine sample collection methods used for young children in the emergency department setting. A probabilistic decision model was constructed, informed by prospective process mapping and a survey of expert clinicians. Costs included equipment, staff time and hospital bed occupancy.
Catheterisation had the lowest average costs to obtain a definitive sample ($102.60), followed by suprapubic needle aspiration ($107.68). However these are invasive collection methods, which may not be possible or practical to perform in some settings. Voiding stimulation using the Quick-Wee method had the lowest average costs of non-invasive methods ($108.53), followed by clean catch ($134.64), and urine bags were the most expensive method ($233.23). Time occupying a hospital bed was the most significant determinant of costs.
This study is the first to directly compare resource use and define the most cost-effective methods to collect urine samples from young children. This is also the first study to include modelling for all relevant and pragmatic considerations used by clinicians to reach a clinical decision. Findings have important implications for clinical practice guideline recommendations. Although clinical factors influence choice of method, considering cost-effectiveness for this common paediatric procedure has the potential for significant aggregate savings.
Kaufman J, Knight A, Bryant P, Babl F, Dalziel K. Liquid Gold: the cost-effectiveness of urine sample collection methods for young pre-continent children. Archives of Disease in Childhood, Published Online First: 23 August 2019. doi: 10.1136/archdischild-2019-317561