TY - JOUR
T1 - Intussusception in children
T2 - Cost-effectiveness of ultrasound vs diagnostic contrast enema
AU - Bucher, Brian T.
AU - Hall, Bruce L.
AU - Warner, Brad W.
AU - Keller, Martin S.
N1 - Funding Information:
This work was funded, in part, through the following grants from the National Institutes of Heath: NIH 5T32GM00879509 (BTB) the St Louis Children's Hospital Foundation-Children's Surgical Sciences Research Institute.
PY - 2011/6
Y1 - 2011/6
N2 - Purpose: The aim of the study was to compare the cost-effectiveness of different imaging strategies for the diagnosis of pediatric intussusception using a decision analytic model. Methods: A Markov decision model was constructed to model effects of radiation exposure at the time of intussusception in a hypothetical cohort of 2-year-old children. The 2 strategies compared were ultrasound followed conditionally by contrast enema (US/CE) vs contrast enema (CE) alone. The model simulated short-term and long-term outcomes of the patients, calculating the average quality-adjusted life years (QALYs) and health care costs associated with each arm. Results: The use of ultrasound as a first-line diagnostic modality would result in a decrease of 79.3 and 59.7 cases of radiation-induced malignancy per 100,000 male and female children evaluated, respectively. For male and female children with intussusception, US/CE was both the most costly initial imaging strategy and the most effective compared with CE. The incremental cost-effectiveness ratios of US/CE to CE was $70,100 (boy) and $92,227 (girl) per quality-adjusted life years gained. Conclusions: In a Markov decision model of pediatric acute intussusception, initial US/CE was both the most costly and the most effective strategy.
AB - Purpose: The aim of the study was to compare the cost-effectiveness of different imaging strategies for the diagnosis of pediatric intussusception using a decision analytic model. Methods: A Markov decision model was constructed to model effects of radiation exposure at the time of intussusception in a hypothetical cohort of 2-year-old children. The 2 strategies compared were ultrasound followed conditionally by contrast enema (US/CE) vs contrast enema (CE) alone. The model simulated short-term and long-term outcomes of the patients, calculating the average quality-adjusted life years (QALYs) and health care costs associated with each arm. Results: The use of ultrasound as a first-line diagnostic modality would result in a decrease of 79.3 and 59.7 cases of radiation-induced malignancy per 100,000 male and female children evaluated, respectively. For male and female children with intussusception, US/CE was both the most costly initial imaging strategy and the most effective compared with CE. The incremental cost-effectiveness ratios of US/CE to CE was $70,100 (boy) and $92,227 (girl) per quality-adjusted life years gained. Conclusions: In a Markov decision model of pediatric acute intussusception, initial US/CE was both the most costly and the most effective strategy.
KW - Cost-effectiveness
KW - Decision analysis
KW - Intussusception
KW - Radiation-induced malignancy
UR - http://www.scopus.com/inward/record.url?scp=79959311559&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2011.03.034
DO - 10.1016/j.jpedsurg.2011.03.034
M3 - Article
C2 - 21683206
AN - SCOPUS:79959311559
SN - 0022-3468
VL - 46
SP - 1099
EP - 1105
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 6
ER -