The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation.
<h4>Objective</h4> <p>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.</p> &...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2017
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| _version_ | 1826302657746173952 |
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| author | Hollingworth, W Busby, J Butler, C O'Brien, K Sterne, J Hood, K Little, P Lawton, M Birnie, K Thomas-Jones, E Harman, K Hay, A |
| author_facet | Hollingworth, W Busby, J Butler, C O'Brien, K Sterne, J Hood, K Little, P Lawton, M Birnie, K Thomas-Jones, E Harman, K Hay, A |
| author_sort | Hollingworth, W |
| collection | OXFORD |
| description | <h4>Objective</h4> <p>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.</p> <h4>Methods</h4> <p>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.</p> <h4>Results</h4> <p>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).</p> <h4>Conclusions</h4> <p>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.</p> |
| first_indexed | 2024-03-07T05:50:55Z |
| format | Journal article |
| id | oxford-uuid:e8d9104f-8c3d-4e97-8ef1-a6859dabbb93 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:50:55Z |
| publishDate | 2017 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:e8d9104f-8c3d-4e97-8ef1-a6859dabbb932022-03-27T10:49:54ZThe Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e8d9104f-8c3d-4e97-8ef1-a6859dabbb93EnglishSymplectic Elements at OxfordElsevier2017Hollingworth, WBusby, JButler, CO'Brien, KSterne, JHood, KLittle, PLawton, MBirnie, KThomas-Jones, EHarman, KHay, A <h4>Objective</h4> <p>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.</p> <h4>Methods</h4> <p>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.</p> <h4>Results</h4> <p>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).</p> <h4>Conclusions</h4> <p>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.</p> |
| spellingShingle | Hollingworth, W Busby, J Butler, C O'Brien, K Sterne, J Hood, K Little, P Lawton, M Birnie, K Thomas-Jones, E Harman, K Hay, A The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation. |
| title | The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation. |
| title_full | The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation. |
| title_fullStr | The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation. |
| title_full_unstemmed | The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation. |
| title_short | The Diagnosis of Urinary Tract Infection in Young Children (DUTY) study clinical rule: Economic evaluation. |
| title_sort | diagnosis of urinary tract infection in young children duty study clinical rule economic evaluation |
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