Screening of Asymptomatic Bacteriuria: Urinalysis or Urine Culture? Which One Is More Cost- Effective?



Farajzadegan Z¹ ; Mirmoghtadaee P² ; Mehrabian F¹ Show Affiliations
Source: Journal of Isfahan Medical School Published:2008

Abstract

Background: Asymptomatic bacteriuria (ABU) is one of the most common problems during pregnancy. In our public health system, screening of ABU by urinalysis (UA) is free for all pregnant women but urine culture (UC) is more sensitive and specific than UA. Determination of condition to screening asymptomatic bacteriuria with urine culture was the main field of the study. Methods: 200 pregnant women in two groups were screened by Dipstick UA and UC. Costs (6) were calculated per groups, and prevented symptomatic bacteriuria was considered as effectiveness (E). Proportion of C/E was estimated. Sensitivity analysis was performed over wide ranges of prevalence of asymptomatic bacteriuria (ASB). Findings: Prevalence of bacteriuria was 4 percent. Direct costs in leukocyte esterasenitrite dipstick group were 723600 Rials and in leukocyte esterase- nitrite dipstick + urine culture group were 1788800 Rials. The incremental costs in first group were 70200 Rials and cost savings in second group were 46800 Rials. The prevention ratio in first group was 55 percent, and in urinalysis +urine culture was 100 percent. The cost- effectiveness ratio in first group was 1.3 and in second group was 1.7. In sensitivity analysis, if prevalence of ASB was 13 percentX -effectiveness of these strategies was equal and if prevalence was 14 percent and higher, the cost- effectiveness with leukocyte esterase- nitrite dipstick+ urine culture was lower than leukocyte esterase- nitrite dipstick group. Conclusion: According to our findings, prevalence of ABU was low, screening of ABU by UA in public system is cost/effective at the present situation, but epidemiologic trend study is necessary to make decision about screening tools. © 2008, Isfahan University of Medical Sciences(IUMS). All rights reserved.