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Screening dipstick urinalysis: a time to change
R E Kaplan1, J E Springate, L G Feld
1Department of Pediatrics, SUNY at Buffalo School of Medicine, and Biomedical Sciences and Children's Hospital, Buffalo, New York, USA.
Pediatrics
|December 31, 1997
Summary
Screening asymptomatic children with multiple dipstick urinalyses is expensive. A single urinalysis at school entry is proposed as a more cost-effective approach for pediatric kidney health.
Area of Science:
- Pediatric Nephrology
- Clinical Cost-Effectiveness Analysis
- Diagnostic Screening
Background:
- Dipstick urinalysis is a common screening tool in pediatric primary care.
- Current guidelines often recommend multiple screenings for asymptomatic children.
- The cost-effectiveness of these repeated screenings is not well-established.
Purpose of the Study:
- To determine the minimal cost of screening dipstick urinalyses in a hypothetical cohort of 2000 asymptomatic pediatric patients.
- To evaluate the cost implications of repeated urinalysis screenings versus a single screening.
Main Methods:
- A hypothetical cohort of 2000 asymptomatic pediatric patients was modeled.
- Costs were calculated based on private practitioner charges for in-office tests, commercial laboratory fees, and specialist consultations.
- Data from published studies were incorporated into the cost analysis.
Main Results:
- An initial abnormal urinalysis was predicted in 9% of patients, with persistent abnormalities in only 1.5%.
- The majority of initial abnormalities (84%) were transient or false positives.
- The minimal cost for four recommended screenings ranged from $20,088 to $25,900, significantly higher than a single screening ($1,290).
Conclusions:
- Multiple screening dipstick urinalyses in asymptomatic pediatric patients are excessively costly.
- Discontinuation of multiple screenings is recommended.
- A single dipstick urinalysis at school entry (ages 5-6) using a first morning void sample is proposed as a more efficient alternative.