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

被引：11

作者：

Shaikh, Nader ^{[1
,2
]}

Rajakumar, Vinod ^{[1
]}

Peterson, Caitlin G. ^{[3
]}

Gorski, Jillian ^{[4
]}

Ivanova, Anastasia ^{[5
]}

Muller, Lisa Gravens ^{[5
]}

Miyashita, Yosuke ^{[2
]}

Smith, Kenneth J. ^{[6
]}

Mattoo, Tej ^{[7
]}

Pohl, Hans G. ^{[8
]}

Mathews, Ranjiv ^{[9
]}

Greenfield, Saul P. ^{[10
]}

Docimo, Steven G. ^{[1
,2
]}

Hoberman, Alejandro ^{[1
,2
]}

机构：

[1] UPMC, Div Gen Acad Pediat, Childrens Hosp Pittsburgh, Pittsburgh, PA 15213 USA

[2] Univ Pittsburgh, Sch Med, Dept Pediat, Pittsburgh, PA 15261 USA

[3] Univ Utah Hlth, Nephrol, Salt Lake City, UT USA

[4] Indiana Univ, Dept Pediat, Indianapolis, IN USA

[5] Univ North Carolina Chapel Hill, Biostat, Chapel Hill, NC USA

[6] Univ Pittsburgh, Div Gen Internal Med, Pittsburgh, PA USA

[7] Wayne State Univ, Sch Med, Nephrol, Detroit, MI USA

[8] Childrens Natl Med Ctr, Washington, DC 20010 USA

[9] Southern Illinois Univ, Sch Med, Springfield, IL USA

[10] Zucker Sch Med, Dept Pediat & Urol, New York, NY USA

来源：

FRONTIERS IN PEDIATRICS | 2020年 / 7卷

关键词：

cost-effectiveness; cost utility; urinary tract infection (UTI); pediatric; pediatric infectious disease; QUALITY-OF-LIFE; KIDNEY-DISEASE; RISK; HEALTH; INFECTIONS; WOMEN;

D O I：

10.3389/fped.2019.00530

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

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.

引用

页数：8

共 31 条

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