Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Health Economics

Background:

• Recurrent urinary tract infections (UTIs) are a concern in children with vesicoureteral reflux (VUR).
• Antimicrobial prophylaxis is a strategy to prevent these infections.
• The RIVUR trial provided data on the efficacy of prophylaxis.

Purpose of the Study:

• To evaluate the cost-effectiveness of antimicrobial prophylaxis for preventing recurrent UTIs in children with VUR.
• To compare the costs and outcomes of prophylaxis versus placebo using RIVUR trial data.

Main Methods:

• A decision tree model was utilized to compare prophylaxis and placebo strategies.
• Costs included medications, imaging, pyelonephritis, surgery, and work loss.
• Sensitivity analyses were performed to assess variable impacts on cost-effectiveness.

Main Results:

• Prophylaxis resulted in higher mean costs ($3092 vs. $2932) but 12.7 fewer infections per 100 children.
• Antibiotics became cost-equivalent if yearly medical costs rose to $386, UTI rates increased to 32%, risk reduction reached 63%, or pyelonephritis rates in placebo were 48%.

Conclusions:

• Antimicrobial prophylaxis is associated with marginally higher costs but significantly fewer UTIs.
• Reduced antibiotic costs or increased UTI incidence in the placebo group could enhance prophylaxis cost-effectiveness.
• The impact on patient and family quality of life should be considered alongside marginal costs.