Jay Pershad1, Teresa M Waters2, Max R Langham3, Tao Li2, Eunice Y Huang4. 1. Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN. 2. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN. 3. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. 4. Department of Surgery, University of Tennessee Health Science Center, Memphis, TN. Electronic address: ehuang@uthsc.edu.
Abstract
BACKGROUND: Our group recently published a clinical pathway (Le Bonheur Clinical Pathway [LeB-P]) that used the Samuel Pediatric Appendicitis Score with selective use of ultrasonography (USG) for diagnosis of children at risk for appendicitis. The objective of this study was to model the cost-effectiveness of implementing the LeB-P compared with usual care. STUDY DESIGN: We constructed a decision analytic model comparing hospital costs for the following diagnostic strategies for suspected appendicitis: emergency department clinician judgment alone, USG on all patients, CT on all patients, overnight observation with surgical evaluation without studies, and the LeB-P. Prevalence of disease, outcomes probabilities, and hospital and professional costs for each option were derived from published literature, national cost data, and our previous study results. Cost-effectiveness was calculated using these 3 sets of parameters. RESULTS: In the base case model, USG was the preferred strategy over LeB-P and overnight observation with surgical evaluation without studies. Emergency department clinician judgment alone and CT were dominated by the other pathways, based on either lower diagnostic accuracy or increased costs. Compared with LeB-P, USG costs $337 less per patient evaluated, but increased the diagnostic error rate by 2%. Using LeB-P rather than USG would cost an institution an additional $17,206 to eliminate one misdiagnosis, which is known as the incremental cost-effectiveness ratio. CONCLUSIONS: Although performing USG on all children with suspected appendicitis was determined to be the most cost-effective strategy, using the Pediatric Appendicitis Score with selective use of USG (LeB-P) improved diagnostic accuracy at a moderate increase in cost and decreased CT use.
BACKGROUND: Our group recently published a clinical pathway (Le Bonheur Clinical Pathway [LeB-P]) that used the Samuel Pediatric Appendicitis Score with selective use of ultrasonography (USG) for diagnosis of children at risk for appendicitis. The objective of this study was to model the cost-effectiveness of implementing the LeB-P compared with usual care. STUDY DESIGN: We constructed a decision analytic model comparing hospital costs for the following diagnostic strategies for suspected appendicitis: emergency department clinician judgment alone, USG on all patients, CT on all patients, overnight observation with surgical evaluation without studies, and the LeB-P. Prevalence of disease, outcomes probabilities, and hospital and professional costs for each option were derived from published literature, national cost data, and our previous study results. Cost-effectiveness was calculated using these 3 sets of parameters. RESULTS: In the base case model, USG was the preferred strategy over LeB-P and overnight observation with surgical evaluation without studies. Emergency department clinician judgment alone and CT were dominated by the other pathways, based on either lower diagnostic accuracy or increased costs. Compared with LeB-P, USG costs $337 less per patient evaluated, but increased the diagnostic error rate by 2%. Using LeB-P rather than USG would cost an institution an additional $17,206 to eliminate one misdiagnosis, which is known as the incremental cost-effectiveness ratio. CONCLUSIONS: Although performing USG on all children with suspected appendicitis was determined to be the most cost-effective strategy, using the Pediatric Appendicitis Score with selective use of USG (LeB-P) improved diagnostic accuracy at a moderate increase in cost and decreased CT use.
Authors: Sonja Kinner; Perry J Pickhardt; Erica L Riedesel; Kara G Gill; Jessica B Robbins; Douglas R Kitchin; Timothy J Ziemlewicz; John B Harringa; Scott B Reeder; Michael D Repplinger Journal: AJR Am J Roentgenol Date: 2017-08-10 Impact factor: 3.959
Authors: Kristin N Partain; Adarsh Patel; Curtis Travers; Courtney E McCracken; Jonathan Loewen; Kiery Braithwaite; Kurt F Heiss; Mehul V Raval Journal: J Pediatr Surg Date: 2016-03-12 Impact factor: 2.545
Authors: Kristin N Partain; Adarsh U Patel; Curtis Travers; Heather L Short; Kiery Braithwaite; Jonathan Loewen; Kurt F Heiss; Mehul V Raval Journal: J Pediatr Surg Date: 2016-12-05 Impact factor: 2.545