Economic and Radiation Costs of Initial Imaging Approaches After a Child’s First Febrile Urinary Tract Infection

• Published in: Clinical pediatrics 2012-01, Vol.51 (1), p.23-30
• Main Authors: Routh, Jonathan C., Grant, Frederick D., Kokorowski, Paul J., Nelson, Caleb P., Fahey, Frederic H., Treves, S. Ted, Lee, Richard S.
• Format: Article
• Language: English
• Subjects: Algorithms; Children & youth; Cost-Benefit Analysis; Decision Support Techniques; Female; Fever; Health care expenditures; Humans; Infant; Male; Medical imaging; Radiation Dosage; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography - economics; Urinary tract diseases; Urinary Tract Infections - diagnostic imaging; Urinary Tract Infections - economics; Vesico-Ureteral Reflux - diagnostic imaging
• ISSN: 0009-9228; 1938-2707
• DOI: 10.1177/0009922811417294

Background. The traditional initial imaging approach following pediatric urinary tract infection is the “bottom-up” approach (cystogram and renal ultrasound). Recently, the “top-down” approach (nuclear renal scan followed by cystogram for abnormal scans only) has gained increasing attention. The relative cost and radiation doses of these are unknown Methods. The authors used a decision model to evaluate these imaging approaches. Cost and effective radiation dose estimates, including sensitivity analyses, were based on one-time imaging only. Results. Comparing hypothetical cohorts of 100 000 children, the top-down imaging approach cost $82.9 million versus $59.2 million for the bottom-up approach. Per-capita effective radiation dose was 0.72 mSv for top-down compared with 0.06 mSv for bottom-up. Conclusions. Routine use of nuclear renal scans in children following initial urinary tract infection diagnosis would result in increased imaging costs and radiation doses as compared to initial cystogram and ultrasound. Further data are required to clarify the long-term clinical implications of this increase.