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Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children
Jonathan Kaufman1,2,3, Andrew Joshua Knight4, Penelope A Bryant5,2,3
1Royal Children's Hospital Melbourne, Parkville, Victoria, Australia jkaufman@unimelb.edu.au.
Insights
Catheterization is the most cost-effective method for collecting urine samples in young children, while urine bags are the most expensive. Considering cost-effectiveness can lead to significant savings in healthcare.
Area of Science:
- Pediatric Emergency Medicine
- Health Economics
- Clinical Diagnostics
Background:
- Urinary tract infections (UTIs) are common in children, often requiring urine samples for diagnosis.
- Urine sample collection in young children can be challenging, leading to delays, contamination, or failure.
- The cost-effectiveness of different pediatric urine collection methods in emergency settings is not well-established.
Purpose of the Study:
- To evaluate and compare the cost-effectiveness of various urine collection methods for precontinent children.
- To identify the most economical approach for obtaining diagnostic urine samples in pediatric emergency departments.
Main Methods:
- A cost-effectiveness analysis compared non-invasive (urine bag, clean catch, voiding stimulation) and invasive (catheterization, suprapubic aspirate) methods.
- Costs included equipment, staff time, and hospital bed occupancy for children aged 0-24 months.
- Sensitivity analyses were performed to assess the impact of various factors on cost-effectiveness.
Main Results:
- Catheterization was the most cost-effective method for both initial and definitive sample collection.
- Urine bags were the most expensive method across all collection scenarios.
- Hospital bed occupancy time was the primary driver of overall costs.
Conclusions:
- Catheterization emerges as the most cost-effective urine collection technique for pediatric patients.
- Voiding stimulation is the most economical non-invasive option.
- Implementing cost-effective strategies for urine collection can yield substantial healthcare savings.
Background:
Urinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown.
Objective:
To determine the cost-effectiveness of urine collection methods for precontinent children.
Methods:
A cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0-24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed.
Results:
For initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost.
Conclusion:
Catheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.
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