Cost-utility analysis of patient care in children with meningeal signs.
OBJECTIVE
We designed a model of diagnostic and therapeutic interventions applied in children with meningeal signs. Using this model, we determined in a cost-utility analysis the consequences for society of different diagnostic strategies in terms of quality-adjusted life-years (QALYs) and costs.


METHODS
Data were used from 360 children (0.1-15 years) visiting the pediatric emergency department of the Sophia Children's Hospital Rotterdam, The Netherlands (1988-98) with meningeal signs. Model inputs included probabilities of meningitis and adverse outcome, QALYs for years lived with long-term sequelae, and costs of tests and treatments. Mean outcome measures were costs and effects of diagnostic and therapeutic interventions in children suspected of bacterial meningitis, key determinants of the model outcomes, and evaluation of alternative diagnostic strategies and two vaccination programs in an analysis.


RESULTS
The population comprised 99 children with bacterial meningitis (adverse outcome in 10), 36 with serious other bacterial infections, and 225 with self-limiting diseases. Key determinants were the risk of bacterial meningitis or sequelae, costs of treatment, and long-term morbidity. Minimizing lumbar punctures and empirical treatments using a diagnostic decision rule, without missing a single case of meningitis, was a dominant strategy to actual practice. Vaccination strategies of Streptococcus pneumoniae and Neisseria meningitidis resulted in our model in incremental cost-utility ratios of 401,965 Euro dollar ([symbol: see text])/QALY and [symbol: see text]22,635/QALY, respectively.


CONCLUSIONS
Costs of long-term morbidity of bacterial meningitis largely outweigh diagnostic and treatment costs. Modeling interventions in children at risk of bacterial meningitis should include long-term consequences in terms of costs and QALYs.
Oostenbrink
Rianne
R
Sophia Children's Hospital and University Utrecht, The Netherlands.
Oostenbrink
Jan B
JB
Moons
Karel G M
KG
Derksen-Lubsen
Gerarda
G
Essink-Bot
Marie-Louise
ML
Grobbee
Diederick E
DE
Redekop
W Ken
WK
Moll
Henriëtte A
HA
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004636:Emergency Service, Hospital / Q000191:economics; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D007223:Infant; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000191:economics* / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000191:economics; D009345:Neisseria meningitidis / Q000276:immunology; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D022242:Pneumococcal Vaccines / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D013296:Streptococcus pneumoniae / Q000276:immunology
D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines