Shaikh Nader, Rajakumar Vinod, Peterson Caitlin G, Gorski Jillian, Ivanova Anastasia, Gravens Muller Lisa, Miyashita Yosuke, Smith Kenneth J, Mattoo Tej, Pohl Hans G, Mathews Ranjiv, Greenfield Saul P, Docimo Steven G, Hoberman Alejandro
Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States.
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Front Pediatr. 2020 Jan 10;7:530. doi: 10.3389/fped.2019.00530. eCollection 2019.
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. 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. 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. 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.
对患有膀胱输尿管反流（VUR）的儿童进行抗菌药物预防可减少尿路感染（UTI）的复发，但需要长期每日使用抗菌药物。我们使用成本效用模型来评估抗菌药物预防的益处是否超过其风险，如果是，则研究益处和风险是否因VUR分级而异。我们比较了首次UTI后诊断为VUR的6岁以下儿童的四种治疗策略中每获得一个质量调整生命年（QALY）的成本，这些治疗策略包括：（1）对所有VUR儿童进行预防；（2）对III级或IV级VUR儿童进行预防；（3）对IV级VUR儿童进行预防；（4）不进行预防。成本和效果是在患者的一生中进行估计的。我们将每获得一个QALY花费100,000美元作为考虑治疗策略具有成本效益的阈值。根据当前数据和考虑数据不确定性的合理范围，对IV级VUR儿童进行预防每获得一个QALY的成本为37,903美元。对III级和IV级VUR儿童进行治疗每获得一个QALY的额外成本为302,024美元。对所有级别的VUR儿童进行治疗每获得一个QALY的额外成本为339,740美元。对I级、II级和III级VUR儿童进行长期抗菌药物预防的成本大大高于通常认为在经济上合理的干预措施。对IV级VUR儿童进行预防具有成本效益。
