A5V4d

Feverish illness in children
Limitations
The economic analysis of PCT versus CRP was based on the best available evidence, which was
completely absent for prevalence of SBI. Also, the sensitivity and specificity data were from a very
limited number of studies of children with FWS. Generally, PCT performs better than CRP in other
situations, so FWS data may not be reliable.
Therefore, great care is needed when interpreting and deriving the final results of this analysis, as
there are some limitations. Sensitivity analysis shows that the final results are sensitive to the
prevalence of SBI and to the levels of diagnostic accuracy at a cost per test of £1.50 and £9.00 for
CRP and PCT, respectively (cost data was from GDG members and not published data). This
indicates that the validity of the results depends considerably on the quality of the data which are
used in order to derive the levels of correct diagnosis.
Another caveat of the model is the choice of outcome measure. The preferred methodology according
to the NICE technical manual is to present outcomes in terms of the quality-adjusted life year (QALY).
Given the range of SBIs under consideration, and the associated range of treatment pathways, it was
impossible to estimate the cost per QALY for these diagnostic tests. This may have some influence
over the results, as some children may undergo unnecessary treatment, while others will not be given
required treatment, based on false results following diagnosis. By measuring the results in cost per
correct diagnosis, the model may not reflect the true long-term costs and outcomes associated with
each diagnostic method.
Conclusions
Using the strong baseline assumptions, CRP appears to be both less costly and to provide more
correct diagnoses than PCT. However, this result was highly sensitive to test accuracies, which were
different in the two studies that reported data for diagnosing SBI in children with fever without
localising signs. PCT became more effective than CRP even with small changes in specificity but this
increase in effectiveness is associated with higher cost per correct diagnosis.
Without conversion to QALYs, it is not possible to assess whether this additional cost is ‘worth’ the
additional benefits of PCT.
Given current published evidence, this economic analysis does not support the replacement of CRP
with PCT in routine practice.
11.5 Hour time limit for an urgent face-to-face
consultation following remote assessment: GDG reasoning
and justification in the absence of data to inform a formal
economic analysis – analysis undertaken for the 2007
guideline
Background
The GDG was asked to produce a guideline to aid healthcare professionals in identifying children with
serious bacterial illness (SBI) in an attempt to reduce mortality and morbidity in young children. During
the guideline development process, the GDG identified evidence-based symptoms and signs that
indicate whether a child has a high risk of having SBI. It also identified symptoms and signs that
indicate that a child is at very low risk of SBI and can be looked after at home. Current practice is
not evidence based and is variable. It is likely that referral patterns from some healthcare providers
will change when the guideline is implemented. It is anticipated that some children who would
previously not always have been recognised as needing specialist attention (a very small proportion
of children who present with fever) will in the future be referred for consultation with a specialist.
Furthermore, a number of children for whom referral is not indicated (the far larger proportion) and
who would previously have been referred for consultation or unnecessary investigations, will now not
be referred unnecessarily under this new guidance. The focus of the guideline is that the right children
should be getting the right treatment at the right time and adverse health outcomes (including death)
will therefore be avoided. The GDG noted the evidence that problem-based guidelines with care
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