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Arch Dis Child. 2019 Aug 23. pii: archdischild-2019-317561. doi: 10.1136/archdischild-2019-317561. [Epub ahead of print]

Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children.

Author information

Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Health Economics Unit, The University of Melbourne School of Population Health, Melbourne, Victoria, Australia.
Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.



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.


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


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.


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.


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.


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

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