Cost-Utility of Antimicrobial Prophylaxis for Treatment of Children With Vesicoureteral Reflux

Frontiers in Pediatrics

article

Nader Shaikh¹  Hans G. Pohl³  Ranjiv Mathews⁴  Saul P. Greenfield⁵  Steven G. Docimo¹  Alejandro Hoberman¹  Vinod Rajakumar¹  Caitlin G. Peterson⁶  Jillian Gorski⁷  Anastasia Ivanova⁸  Lisa Gravens Muller⁸  Yosuke Miyashita²  Kenneth J. Smith⁹  Tej Mattoo^1,10 

[1] Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, United States;Department of Pediatrics, University of Pittsburgh School of Medicine, United States;Children's National Medical Center, United States;Southern Illinois University School of Medicine, United States;Department of Pediatrics and Urology, Zucker School of Medicine, United States;University of Utah Health, United States;Department of Pediatrics, Indiana University, United States;University of North Carolina at Chapel Hill, United States;Division of General Internal Medicine, University of Pittsburgh, United States;Wayne State University School of Medicine, United States

关键词: cost-effectiveness;    cost utility;    urinary tract infection (UTI);    pediatric;    pediatric infectious disease;   

DOI  :  10.3389/fped.2019.00530

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objective: Antimicrobial prophylaxis for children with vesicoureteral reflux (VUR) reduces recurrences of urinary tract infection (UTI) but requires daily antimicrobials for extended periods. We used a cost-utility model to evaluate whether the benefits of antimicrobial prophylaxis outweigh its risks and, if so, to investigate whether the benefits and risks vary according to grade of VUR. Methods: We compared the cost per quality-adjusted life-year (QALY) gained in four treatment strategies in children aged <6 years diagnosed with VUR after a first UTI, considering these treatment strategies: (1) prophylaxis for all children with VUR, (2) prophylaxis for children with Grade III or Grade IV VUR, (3) prophylaxis for children with Grade IV VUR, and (4) no prophylaxis. Costs and effectiveness were estimated over the patient's lifetime. We used $100,000/QALY gained as the threshold for considering a treatment strategy cost effective. Results: Based on current data and plausible ranges to account for data uncertainty, prophylaxis of children with Grades IV VUR costs $37,903 per QALY gained. Treating children with Grade III and IV VUR costs an additional $302,024 per QALY gained. Treating children with all grades of VUR costs an additional $339,740 per QALY gained. Conclusions: Treating children with Grades I, II, and III VUR with long-term antimicrobial prophylaxis costs substantially more than interventions typically considered economically reasonable. Prophylaxis in children with Grade IV VUR is cost effective.

【 授权许可】

CC BY