A5V4d

11 Health economics
11.1 Cost analysis of thermometers for use in children
and infants with fever
Introduction
A cost analysis of the various types of thermometers available in the UK was undertaken for the 2007
guideline in order to demonstrate the range of costs associated with thermometers. The prices for
each type of thermometer were obtained from a review of clinical thermometers in the UK market
published by the Medicines and Healthcare products Regulatory Agency (MHRA). 27 This review
provided an overview of the clinical and procurement issues for each reported thermometer.
The report showed that the price of ‘stand-alone’ thermometers is highly variable. Prices range from
7p each for disposable chemical thermometers to £400 for some models of electronic contact
thermometers. Given this variation, it is important to take into account a range of issues before
determining which device is the best choice and achieves best practice.
Apart from the cost of purchasing it is necessary to consider the cost associated with the use of them.
For instance, the manufacturers of some thermometers recommend the use of specific disposable
covers to help to reduce the risk of cross-infection for those devices that cannot be adequately
cleaned. Also, in some cases it may be necessary to take into account the cost of training for the
clinical staff. The clinical risk from incorrect readings may be reduced by the staff undertaking
competency-based training programmes. Some electronic thermometers are battery powered so the
cost of battery replacement should be included in a detailed costing analysis of thermometers. Also,
the cost of recalibration and the cost of maintenance are important elements of cost for some specific
types of thermometer.
11.2 Description of the costing analysis
In general, thermometry can be categorised by the type of the instrument used and by the site at
which the temperature is read. Mercury in glass, electronic and chemical dot thermometers can be
used sublingually (orally), in the axilla (under arm) or rectally. Temperature assessment accuracy is
critically important. False high readings may lead to expensive and unnecessary painful diagnostic
tests and medical interventions. False low readings may lead to greater morbidity and mortality.
Accuracy of body temperature measurement depends not only on the type of thermometer but also on
the site of measurement. Given that the site of measurement is a clinically important decision, the
classification of the thermometers for this cost analysis was based on the site of measurement. Some
types of thermometers cannot provide readings from all the sites of measurements. For instance,
chemical thermometers cannot give rectal measurements.
Methods
The structure of the cost analysis and the assumptions in it are based on that devised by Crawford et
al. 27 The analysis includes three types of thermometer: chemical, electronic and infrared sensing, and
classified according to two different sites of measurements: axilla and tympanic.
The thermometers were subdivided into subcategories of electronic and chemical thermometers since
there are cost differences between them. The category of electronic thermometers was split into
contact/electronic and contact/compact electronic thermometers.
A robust cost comparison between different technologies should ideally encompass all the
contributory costs over a prescribed period: in this case, a 10 year time horizon was used, discounted
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