OBJECTIVES: To establish if the procalcitonin (PCT) test’s diagnostic performance is more clinically and cost-effective than C reactive protein (CRP) and White Cell Count (WCC) tests for suspicion of prodomal stage Meningococcal disease (MD) in children presenting at emergency department (ED) with a fever without source.    METHODS: A decision analytic model was designed to reflect realistic clinical pathways for a child presenting with non-specific fever to ED.  Test accuracy was evaluated using data from independent studies carried out in developed countries identified through a systematic literature search.  Studies were combined to determine the optimal cut-off value for the PCT, CRP and WCC tests, each as an indicator of MD.  Summary Receiver Operator Curve (SROC) analysis was used to determine the inter-study and overall diagnostic performance of each test from the areas under the curve (AUC), with 95% confidence intervals (CIs).  Components of each clinical pathway were costed in UK sterling using the National Schedule of Reference Costs 2010-2011.  Hospital stays were costed using the appropriate Health Resource Group code.   RESULTS: Seven studies involving 881 children with non-specific fever provided data for inclusion.  The PCT test was more accurate (sensitivity=89%, 95%CI=75-96; specificity=71%, 95%CI=37-91) for early MD compared to CRP (sensitivity=84%, 95%CI=74-90; specificity=60%, 95%CI=44-74) and WCC (sensitivity=50%, 95%CI=39-60; specificity=68%, 95%CI=54-79).  PCT had the best PLR (3.0, 95%CI=1.8-7.8) to be viable as a rule-in test for MD and a borderline NLR as a rule-out test, making it a better option to either CRP (2.1, 95%CI=1.4-3.1) or WCC (1.5, 95%CI=1.0-2.3). Outcomes from the decision analytic model indicated that the PCT test was the most cost-effective (£2547 per patient treated), followed by the combined CRP and WCC test (£3069 per patient treated).  CONCLUSIONS: The improved sensitivity and specificity of the PCT test provides a more cost-effective test than the currently recommended CRP and WCC tests.