A5V4d

Feverish illness in children
(£500,000/£70) patients could be seen for face-to-face assessment, this would be cost-effective if it
saved one additional child’s life.
This does not take into account the potential savings from preventing the health and social care costs
of serious morbidity in children which would make the intervention more cost-effective. Nor does it
take into account that the carers of children with ‘red’ symptoms will contact health services
somehow, and the guideline emphasises the fact that this should almost always be primary care in
the first instance. This is a less expensive option than A&E services which cost £77–105 per visit for
2005/06, depending on the cost of investigations. 250
This very brief analysis of cost-effectiveness assumes that at least three children’s deaths are
prevented every year in the district general hospital by putting in place a 2 hour assessment in a
population of 250,000, and there are children are currently at risk of death and serious morbidity who
are not currently being urgently assessed and referred for specialist advice. It also assumes that all
children at risk of death from SBI are seen eventually by a healthcare professional, and do not die at
home without any health service contact. It is assumed that deaths can be prevented by more timely
referral to specialist services for those children who urgently need it, and that the cost of
investigations and initial management once reaching a specialist care unit would be the same at
whatever stage they were referred (that is, a standard package of investigations and management of
a child with suspected SBI would be initiated).
Clearly there are costs around diagnosis and initial management of a child with suspected SBI once
they reach specialist services, but the GDG was not clear that these would be any different (whether
higher costs if a child is referred urgently or higher if referred after a delay of more than 2 hours).
Without empirical data, these assumptions cannot be verified, but the GDG members believe that
these are conservative assumptions that reflect the real world closely enough to make the assertion
that the 2 hour face-to-face referral is very likely to be cost-effective.
Conclusion
The aim of this guideline is to improve the identification of those children who are genuinely at a high
risk of serious illness and require urgent assessment and treatment to prevent death and serious
morbidity. Using the traffic light system, those children in the ‘red’ category have been identified as
being at a high risk of serious illness and the GDG believes that it is already established best clinical
and cost-effective practice for this small group to be seen urgently within 2 hours and this guidance
will reinforce that practice. The guideline will also reduce unnecessary assessment (urgent and
routine) and diagnostic testing of children who are at low risk of serious illness.
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