OBJECTIVES: The optimal practice management of highly febrile 3- to 36-month-old @entity1 without a focal source has been controversial. The recent release of a conjugate pneumococcal vaccine may reduce the rate of @entity2259 and alter the utility of empiric testing and treatment. The objective of this study was to determine the cost-effectiveness of 6 different management strategies of febrile 3- to 36-month-old @entity1 at current and declining rates of @entity2259 . METHODS: A cost-effectiveness (CE) analysis was performed to compare the strategies of "no work-up," "clinical judgment," "blood culture," "blood culture + treatment," "complete blood count (CBC) + selective blood culture and treatment," and "CBC and blood culture + selective treatment." A hypothetical cohort of 100 000 @entity1 who were 3 to 36 months of age and had a fever of >/=39 degrees C and no source of infection was modeled for each strategy. Our main outcome measures were cases of @entity693 prevented, life-years saved compared with "no work-up," total cost (1999 dollars), and @entity24882 . RESULTS: When compared with "no work-up," the strategy of "CBC + selective blood culture and treatment" using a white blood cell (WBC) cutoff of 15 x 10(9)/L prevents 48 cases of @entity693 , saves 86 life-years per 100 000 @entity1 , and is less costly at the current rate of @entity2259 (1.5%). Using the strategy of "CBC + selective blood culture and treatment" with a lower WBC cutoff of 10 x 10(9)/L costs an additional  72 300 per life-year saved. If the rate of @entity2259 declines to 0.5%, then the incremental CE ratio of "clinical judgment" compared with "no work-up" is  38 000 per life-year saved; however, strategies that include empiric testing or treatment result in CE ratios greater than  300 000 per life-year saved. CONCLUSIONS: "CBC + selective blood culture and treatment" using a WBC cutoff of 15 x 10(9)/L is cost-effective at the current rate of @entity2259 . If the rate of @entity2259 falls below 0.5% with widespread use of the conjugate pneumococcal vaccine, then strategies that use empiric testing and treatment should be eliminated.

Management of febrile XXXX in the age of the conjugate pneumococcal vaccine: a cost-effectiveness analysis.

@entity1 :: ('9606', 'Species') :: ['children', 'patients'] @entity2259 :: ('MESH:D016470', 'Disease') :: ['bacteremia', 'occult pneumococcal bacteremia', 'occult bacteremia', 'pneumococcal bacteremia'] @entity24882 :: ('MESH:D065606', 'Disease') :: ['incremental CE ratios'] @entity693 :: ('MESH:D008581', 'Disease') :: ['meningitis']
@entity1 :: (9606,Species) :: ['children']
