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Titolo:
Management of febrile children in the age of the conjugate pneumococcal vaccine: A cost-effectiveness analysis
Autore:
Lee, GM; Fleisher, GR; Harper, MB;
Indirizzi:
Childrens Hosp, Div Infect Dis, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 , Div Infect Dis, Boston, MA 02115 USA Childrens Hosp, Div Gen Pediat, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 , Div Gen Pediat, Boston, MA 02115 USA Childrens Hosp, Div Emergency Med, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 iv Emergency Med, Boston, MA 02115 USA
Titolo Testata:
PEDIATRICS
fascicolo: 4, volume: 108, anno: 2001,
pagine: 835 - 844
SICI:
0031-4005(200110)108:4<835:MOFCIT>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESISTANT STREPTOCOCCUS-PNEUMONIAE; 3-YEAR MULTICENTER SURVEILLANCE; RECENT PRACTICE GUIDELINES; OCCULT BACTEREMIA; BACTERIAL-MENINGITIS; ANTIBIOTIC-THERAPY; UNITED-STATES; PEDIATRIC EMERGENCY; YOUNG-CHILDREN; RISK;
Keywords:
fever; occult bacteremia; conjugate pneumococcal vaccine; cost-effectiveness analysis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
65
Recensione:
Indirizzi per estratti:
Indirizzo: Lee, GM Childrens Hosp, Div Infect Dis, 300 Longwood Ave, Boston, MA 02115USA Childrens Hosp 300 Longwood Ave Boston MA USA 02115 , MA 02115 USA
Citazione:
G.M. Lee et al., "Management of febrile children in the age of the conjugate pneumococcal vaccine: A cost-effectiveness analysis", PEDIATRICS, 108(4), 2001, pp. 835-844

Abstract

Objectives. The optimal practice management of highly febrile 3- to 36-month-old children without a focal source has been controversial. The recent release of a conjugate pneumococcal vaccine may reduce the rate of occult bacteremia and alter the utility of empiric testing and treatment. The objective of this study was to determine the cost-effectiveness of 6 different management strategies of febrile 3- to 36-month-old children at current and declining rates of occult pneumococcal bacteremia. Methods. A cost-effectiveness (CE) analysis was performed to compare the strategies of "no work-up," "clinical judgment," "blood culture," "blood culture + treatment," "complete blood count (CBC) + selective blood culture and treatment," and "CBC and blood culture + selective treatment. " A hypothetical cohort of 100 000 children who were 3 to 36 months of age and had a fever of greater than or equal to 39 degreesC and no source of infection was modeled for each strategy. Our main outcome measures were cases of meningitis prevented, life-years saved compared with "no work-up," total cost (1999dollars), and incremental CE ratios. Results. When compared with "no work-up," the strategy of "CBC + selectiveblood culture and treatment" using a white blood cell (WBC) cutoff of 15 x10(9)/L prevents 48 cases of meningitis, saves 86 life-years per 100 000 patients, and is less costly at the current rate of bacteremia (1.5%). Usingthe strategy of "CBC + selective blood culture and treatment" with a lowerWBC cutoff of 10 x 10(9)/L costs an additional $72 300 per life-year saved. If the rate of bacteremia declines to 0.5%, then the incremental CE ratioof "clinical judgment" compared with "no work-up" is $38 000 per life-yearsaved; however, strategies that include empiric testing or treatment result in CE ratios greater than $300 000 per life-year saved. Conclusions. "CBC + selective blood culture and treatment" using a WBC cutoff of 15 x 10(9)/L is cost-effective at the current rate of pneumococcal bacteremia. If the rate of occult bacteremia falls below 0.5% with widespread use of the conjugate pneumococcal vaccine, then strategies that use empiric testing and treatment should be eliminated.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/01/21 alle ore 16:17:19