Abstract

Objective

The optimal practice management of highly febrile 1- to 3-month-old children without a focal source has been controversial. The release of a conjugate pneumococcal vaccine may reduce the rate of occult bacteremia and alter the utility of empiric testing. The objective of this study was to determine the cost-effectiveness of 3 different screening strategies of Serious Bacterial Infections (SBI) in Children Presenting with Fever without Source in Argentina.

Methods

Cost-effectiveness (CE) analysis was performed to compare the strategies of procalcitonin, C reactive protein and Rochester criteria. A hypothetical cohort of 10 000 children who were 1 to 3 months of age and had a fever of >39°C and no source of infection was modeled for each strategy. Our main outcome measure was incremental CE ratios.

Results

C reactive protein result in US$ 937 per correctly diagnosed cases of SBI. The additional cost per additional correct diagnosis using procalcitonin versus C reactive protein was U$6127 while Rochester criteria resulted dominated.

Conclusions

C reactive protein is the strategy more cost-effective to detect SBI in children with Fever without Source in Argentina. Due to low proportion of correctly diagnosed cases ( an individualized approach for children with fever is still necessary to optimize diagnostic investigations and treatment in the different emergency care settings.