Costs and Consequences of Universal Sibling Screening for Vesicoureteral Reflux: Decision Analysis

Abstract

OBJECTIVE Our objective was to evaluate screening for vesicoureteral reflux (VUR) among siblings of patients with VUR, in terms of cost, radiation exposure, and number of febrile urinary tract infections (fUTIs) averted. METHODS We constructed a Markov model to evaluate 2 competing management options, that is, universal screening (cystographic evaluation of all siblings without symptoms) and usual care (cystographic evaluation of siblings only after fUTIs). Published data were used to inform all model inputs. Costs were estimated by using a societal perspective. RESULTS Universal screening yielded 2980 fUTIs, whereas usual care yielded 6330. Therefore, universal screening for VUR in a cohort of 100 000 siblings 1 year of age without symptoms resulted in the prevention of 1 initial fUTI per 3360 siblings, at an excess cost of $55 600 per averted fUTI, in comparison with usual care. These estimates were heavily dependent on screening age and the effectiveness of antibiotic prophylaxis; prevention of a single fUTI would require screening of 166 siblings 5 years of age and 694 siblings 10 years of age. Similarly, if prophylaxis was ineffective in preventing fUTIs, then up to 10 000 siblings would need to be screened for prevention of a single fUTI. CONCLUSIONS Prevention of a single fUTI would require screening of 30 to 430 siblings 1 year of age without symptoms, at an estimated excess cost of $56000 to $820000 peraverted fUTI. These estimates are heavily dependent on screening age and the effectiveness of antibiotic prophylaxis.

Epidemiology and Clinical Research Design, Part 2: Principles

“…However, because the brother is only 1 year old, the probability of VUR is higher (approximately 50%). (19) The decision analysis approach shown in Figure 7 provides a formal, transparent, and orderly analytic approach to assist in decisionmaking by parents and practitioners. On the basis of these numbers, a decision may be made regarding whether this 18-month-old sibling should undergo screening at the pediatrician’s office and be scheduled for a VCUG and renal sonogram.…”

“…A decision is needed on appropriate approach to his 18-month-old asymptomatic brother based on available evidence. (19)…”

Persistent candidemia in very low birth weight neonates: risk factors and clinical significance

“…Candidemia is the third most common nosocomial bloodstream infection during late-onset neonatal sepsis [ 1 ]. It affects 10 to 20% of extremely low birth weight infants and 2 to 16% of very low birth weight neonates and is responsible for 25 to 30% of morbidity in neonatal intensive care units (NICUs) [ 2 – 7 ]. It was reported that the infants who survive candidemia frequently have long-term neurodevelopmental impairment, which occurred in 57% of these high-risk infants [ 7 ].…”

Candidíase invasiva e alterações bucais em recém-nascidos prematuros

“…Invasive candidiasis is the second cause of mortality due to infectious diseases in preterm NB and represents 10% of all sepsis cases. It is the major cause of late infection in preterm NB ( 2 , 3 , 5 , 12 ) with varying incidence and high mortality ( 4 – 8 ) . Long hospital stay and exposure to environmental factors, as well as contact with other patients or transmission by health professionals with hands colonized with fungi are important causes of opportunistic infections ( 25 ) .…”

“…can be vertical, transmitted from mother to baby during birth, or horizontal, due to external contamination ( 7 , 8 ) . Other relevant risk factors are: prematurity and immaturity of the immune system, weakened physical barriers, colonization, and exposure to environmental factors, such as central venous catheter, prolonged use of endotracheal tube, H2 blockers, prolonged use of antibiotics or steroids, parenteral nutrition, long hospital stay, recent surgery, dialysis, maternal hypertension, restricted intrauterine growth, asphyxia, hospital infection and advanced maternal age at gestation ( 2 , 3 , 5 – 8 , 10 – 15 ) .…”