A5V4d

Feverish illness in children
The nursing cost per hour (£22) was the hourly cost for a staff nurse on a 24 hour ward published in
the Unit Costs of Health and Social Care for 2006, 242 which was based on the Agenda for Change
salaries for the April 2005 scale at the midpoint for Band 5 (with qualifications).
It should be noted that the analysis did not take into account the additional staff time to change
batteries and undertake basic performance checks, although it was recognised that for some models
the manufacturers recommend (at least annual) performance and accuracy checks using specialised
equipment that can be arranged when a battery needs replacement.
The costs of calibration (a specialised accuracy check) and warranty are not included in the analysis,
which is a limitation of the model.
The cost of cleaning (alcohol wipes) is included where these are required after each measurement.
For the contact/chemical thermometers used on a single patient, alcohol wipes are not required. For
the contact/compact electronic thermometers (axilla using disposable covers), alcohol cleaning of the
thermometer body is only required ‘when needed’ and this is unlikely to be after every measurement.
Therefore it was assumed that an alcohol wipe was used after every 50 measurements.
An approximation of 18 readings per inpatient episode was estimated by dividing the estimated
number of measurements per year by the number of inpatient episodes per year, and rounding up to
the nearest whole number.
Using the above assumptions, the overall cost for each type of thermometer was calculated for those
which can provide axilla and ear measurements. The total cost for each type of thermometer for 10
years was calculated using for each site of measurement the minimum and maximum price of the
thermometers.
The clinical accuracy of the thermometers is assumed to be the same for all models of thermometer
and in all measurement sites in this analysis. This is due to the lack of data on comparative accuracy
or ability to detect fever by different models of thermometer, and the lack of data on the impact of
temperature accuracy on time to correct diagnosis and initiation of clinical management in children
with suspected serious bacterial infection. The assumption is that, used correctly, all the
thermometers considered in this analysis can detect a clinically important rise in temperature.
Results
Axilla measurements
Tables 11.2 and 11.3 show the results of the cost analysis for axilla measurement showing the
comparative costs over 10 years using maximum and minimum prices for each type of thermometer.
Table 11.2 indicates that, in an acute care setting, using the least cost models available on axilla sites
and including the cost of staff, the compact contact electronic thermometer is the best value for
money, followed by the reusable contact/chemical thermometer, although this is four times more
expensive. The cheapest electronic contact and the single-use chemical thermometers are more than
12 times more expensive than the cheapest contact/electronic thermometer. The large difference in
staff time required to take a temperature (5 seconds versus 3 minutes) account for much of the large
difference in cost between these types of thermometer.
Table 11.3 shows that using the most expensive models of reusable chemical thermometers in terms
of initial purchase price can be less costly over 10 years than the cheaper models. The total cost of
the high-priced model including staff time was more than 12 times less than the total cost using the
cheapest priced reusable chemical thermometer because the expensive model took only 5 seconds to
read after the first initial 3 minute reading. Overall, the results suggest that, in an acute care setting,
the best option for a top of the range thermometer was the reusable chemical model, followed by the
compact contact electronic model. The worst option was the single-use chemical thermometer which
cost over £20 million over 10 years (£14 million when discounted by 3.5%), which was over 14 times
more expensive than the next most expensive, which was the electronic contact model
(undiscounted).
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