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Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children
  1. Jonathan Kaufman1,2,3,
  2. Andrew Joshua Knight4,
  3. Penelope A Bryant1,2,3,
  4. Franz E Babl1,2,3,
  5. Kim Dalziel3,4
  1. 1 Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  4. 4 Health Economics Unit, The University of Melbourne School of Population Health, Melbourne, Victoria, Australia
  1. Correspondence to Dr Jonathan Kaufman, Health Services Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville VIC 3052, Australia; jkaufman{at}


Background Urinary 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.

Objective To determine the cost-effectiveness of urine collection methods for precontinent children.

Methods A 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.

Results For 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.

Conclusion Catheterisation 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.

  • urinary tract infection
  • urine specimen collection
  • health resources
  • economic model
  • child

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  • Contributors JK was the lead author of the manuscript. All authors contributed to the initial study design. JK completed the literature review and acquired all data for the clinician survey, process mapping and cost analysis. JK designed the economic model and completed the analysis with substantial input from AK and KD who supervised the modelling and interpretation of results. PAB and FEB contributed to clinical aspects of the model. JK wrote the first draft of the manuscript, and all authors contributed to revising the manuscript. All authors had final approval of the version to be published. JK and KD take responsibility for the paper as a whole.

  • Funding JK is supported in part by an Australian Government Research Training Program Scholarship and Melbourne Children’s Postgraduate Health Research Scholarship. FEB is supported in part by a National Health and Medical Research Council Practitioner Fellowship and Melbourne Children’s Clinician Scientist Fellowship. PAB is supported in part by a Melbourne Children’s Clinician Scientist Fellowship. KD and AJK declare no funding related to this paper. The RCH Melbourne receives infrastructure support from the Victorian Government’s Infrastructure Support Program, Melbourne, Australia.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol (HREC reference 35083E) was approved by the Royal Children’s Hospital human research ethics committee. All participants gave informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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