Cost Analysis of the Management of Pediatric Febrile UTI: Traditional, AAP, and Population Health Algorithms
The management of Pediatric febrile or symptomatic UTI has been controversial since the release of the American Academy of Pediatrics (AAP) guidelines in 2011. Whereas traditional management evaluated patients for reflux after first UTI, AAP recommended evaluation after the second episode. Furthermore, population health algorithms have emerged with the goal of reducing resource utilization by focusing on prompt UTI treatment and aggressive management of bowel and bladder dysfunction. We hypothesized that delaying evaluation for reflux would translate in to significant cost reductions from the payer’s perspective.
A decision tree model was created evaluating Traditional, AAP, and a Population Health algorithm for the management of Pediatric UTI. The index patient is a child aged 2 to 71 months with a febrile or symptomatic UTI. A total of three UTIs were modeled over the course of two years. Probabilities were based on the RIVUR and CUTIE studies. Costs were calculated from the perspective of the payer, and were based on Centers for Medicare and Medicaid services data and prior peer-reviewed publications written by the authors.
Three different strategies were evaluated for the management of Pediatric UTI (Figure 1). The estimated per-patient cost of the Traditional model is $1,935.94, AAP $919.92, and Population Health $916.98. Due to the fact that Population Health utilizes empiric antibiotic prophylaxis for all patients with second UTI regardless of reflux status, the model was sensitive to the cost of prophylaxis (Figure 2). At antibiotic costs below $300, Population Health was the least costly strategy. At costs above $300, AAP was least costly. The Traditional model was the most expensive in all scenarios evaluated.
Deferring evaluation of reflux beyond the incident UTI results in significant cost savings due to reductions in overall resource utilization. The least costly strategy varies according to the cost of two years of antibiotic prophylaxis.