Liquid Gold: The Cost Effectiveness of Urine Sample Collection Methods for Young Pre-Continent Children

BackgroundUrinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown.ObjectiveTo determine the cost-effectiveness of urine collection methods for precontinent children.MethodsA cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0–24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed.ResultsFor initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost.ConclusionCatheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.

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Potential Cost-effectiveness of HIV Viral Load Sample Collection and Testing Methods in Malawi

10.21203/rs.2.13295/v1 ◽

2019 ◽

Author(s):

Joseph B. Babigumira ◽

Solomon J. Lubinga ◽

Mindy M. Cheng ◽

James K. Karichu ◽

Louis P. Garrison

Keyword(s):

Viral Load ◽

Cost Effectiveness ◽

Treatment Failure ◽

Test Accuracy ◽

Sample Collection ◽

Testing Methods ◽

Hiv Viral Load ◽

Potential Cost ◽

Testing Approach ◽

The Cost

Abstract Background HIV viral load (VL) monitoring informs antiretroviral therapy failure and helps to guide regimen changes. Typically, VL monitoring is performed using dried blood spot (DBS) samples transported and tested in a centralized laboratory. Novel sample collection technologies based on dried plasma stored on a plasma separation card (PSC) have become available. The cost-effectiveness of these different testing approaches to monitor VL is uncertain, especially in resource-limited settings. The objective of this study is to evaluate the potential cost-effectiveness of HIV VL testing approaches with PSC samples compared to DBS samples in Malawi. Methods We developed a decision-tree model to evaluate the cost-effectiveness of two different sample collection and testing methods—DBS and PSC samples transported and tested at central laboratories. The analysis used data from the published literature and was performed from the Malawi Ministry of Health perspective. We estimated costs of sample collection, transportation, and testing. The primary clinical outcome was test accuracy (proportion of patients correctly classified with or without treatment failure). Sensitivity analysis was performed to assess the robustness of results. Results The estimated test accuracy for a DBS testing approach was 87.5% compared to 97.4% for an approach with PSC. The estimated total cost per patient of a DBS testing approach was $19.39 compared to $17.73 for a PSC approach. Based on this, a PSC-based testing approach “dominates” a DBS-based testing approach (i.e., lower cost and higher accuracy). Conclusion The base-case analysis shows that a testing approach using PSC sample is less costly and more accurate (correctly classifies more patients with or without treatment failure) than with a DBS approach. Our study suggests that a PSC testing approach is likely an optimal strategy for routine HIV VL monitoring in Malawi. However, given the limited data regarding sample viability, additional real-world data are needed to validate the results.

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Degassed PDMS pump for controlled extraction from dried filter samples in microfluidic devices

Analytical Methods ◽

10.1039/c6ay01880g ◽

2016 ◽

Vol 8 (47) ◽

pp. 8266-8271 ◽

Cited By ~ 2

Author(s):

Rachel M. Feeny ◽

Nicole L. Puissant ◽

Charles S. Henry

Keyword(s):

Microfluidic Devices ◽

Sample Collection ◽

The Cost ◽

Collection Methods

Simplified sample collection methods can continue to advance the field of biosensors by decreasing the cost required to acquire and store samples and/or increasing the number of locations where the sensors can be used.

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What’s the catch? Urine sample collection from young pre-continent children: a qualitative study in primary care.

BJGP Open ◽

10.3399/bjgpopen20x101060 ◽

2020 ◽

Vol 4 (4) ◽

pp. bjgpopen20X101060

Author(s):

Jonathan Kaufman ◽

Lena Sanci ◽

Meredith Temple-Smith

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Urine Sample ◽

Urine Samples ◽

Future Research ◽

Sample Collection ◽

Structured Interviews ◽

Barriers And Enablers ◽

Tract Infections ◽

Collection Methods

BackgroundUrinary tract infections (UTIs) are common in young pre-continent children, but collecting urine samples is challenging. Collection methods all have limitations and international guidelines have conflicting recommendations. Choice of method must balance time, resources, invasiveness, reliability, and contamination. Evidence from primary care clinicians is limited regarding barriers and enablers to sample collection, and what factors inform the choice and use of different sample collection methods.AimTo understand the barriers and enablers to collecting urine samples from young pre-continent children in primary care.Design & settingAn exploratory qualitative study performed in primary care in Australia.MethodSemi-structured interviews explored the topic of collecting a urine sample from a child aged 6 months who presented with a fever. The interviews were undertaken with 21 GPs and four practice nurses (PNs) until data saturation was reached. Interviews were audiorecorded, transcribed verbatim, coded, and underwent content and thematic analysis.ResultsFive main themes emerged including: the clinician’s knowledge and expertise; patient characteristics; parent or carer’s understanding and motivation; the collection process itself; and likely outcome of the chosen method. Non-invasive methods were strongly favoured; although, clean catch was considered time-consuming and urine bags were known to be often contaminated. Invasive methods (for example, catheterisation or suprapubic aspiration [SPA]) were rarely performed outside of remote settings. Key barriers included time and space constraints in clinics, and key enablers included parental motivation, education handouts, and voiding stimulation methods.ConclusionThis study has identified key barriers and enablers to inform education, policy, and future research for urine sample collection from pre-continent children in primary care. Guideline recommendations must consider the primary care context to ensure they are relevant and suited to real-world practice.

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The cost-effectiveness of scaling-up rapid point-of-care testing for early infant diagnosis of HIV in southern Zambia

PLoS ONE ◽

10.1371/journal.pone.0248217 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248217

Author(s):

Gatien De Broucker ◽

Phillip P. Salvatore ◽

Simon Mutembo ◽

Nkumbula Moyo ◽

Jane N. Mutanga ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Outcomes ◽

Point Of Care ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Early Infant Diagnosis ◽

Sample Collection ◽

Art Initiation ◽

Early Infant ◽

The Cost

Introduction Early infant diagnosis (EID) and treatment can prevent much of the HIV-related morbidity and mortality experienced by children but is challenging to implement in sub-Saharan Africa. Point-of-care (PoC) testing would decentralize testing and increase access to rapid diagnosis. The objective of this study was to determine the cost-effectiveness of PoC testing in Southern Province, Zambia. Methods A decision tree model was developed to compare health outcomes and costs between the standard of care (SoC) and PoC testing using GeneXpert and m-PIMA platforms. The primary health outcome was antiretroviral treatment (ART) initiation within 60 days of sample collection. Additional outcomes included ART initiation by 12 months of age and death prior to ART initiation. Costs included both capital and recurrent costs. Health outcomes and costs were combined to create incremental cost effectiveness ratios (ICERs). Results The proportion of children initiating ART within 60 days increased from 27.8% with SoC to 79.8–82.8% with PoC testing depending on the algorithm and platform. The proportion of children initiating ART by 12 months of age increased from 50.9% with SoC to 84.0–86.5% with PoC testing. The proportion of HIV-infected children dying prior to ART initiation decreased from 18.1% with SoC to 3.8–4.6% with PoC testing. Total program costs were similar for the SoC and GeneXpert but higher for m-PIMA. ICERs for PoC testing were favorable, ranging from $23–1,609 for ART initiation within 60 days, $37–2,491 for ART initiation by 12 months of age, and $90–6,188 for deaths prior to ART initiation. Factors impacting the costs of PoC testing, including the lifespan of the testing instruments and integrated utilization of PoC platforms, had the biggest impact on the ICERs. Integrating utilization across programs decreased costs for the EID program, such that PoC testing was cost-saving in some situations. Conclusion PoC testing has the potential to improve linkage to care and ART initiation for HIV-infected infants and should be considered for implementation within EID programs to achieve equity in access to HIV services and reduce HIV-related pediatric morbidity and mortality.

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