Evaluation of heart murmurs in children: cost-effectiveness and practical implications

Title

Evaluation of heart murmurs in children: cost-effectiveness and practical implications

Creator

Yi MS; Kimball TR; Tsevat J; Mrus JM; Kotagal UR

Publisher

The Journal Of Pediatrics

Date

2002

Subject

Child; Humans; infant; Prevalence; Decision Support Techniques; Sensitivity and Specificity; Infant Welfare; adolescent; Preschool; Non-U.S. Gov't; Research Support; infant; Comparative Study; Newborn; Child welfare; Radiography; Cardiology/economics; Cost-Benefit Analysis/economics; Echocardiography/economics; Electrocardiography/economics; Heart Murmurs/diagnosis/economics/epidemiology; Pediatrics/economics; Referral and Consultation/economics; Thoracic/economics

Description

OBJECTIVE: To assess the cost-effectiveness of various strategies to evaluate heart murmurs in children. METHODS: We modeled 6 strategies to follow the initial examination by the pediatrician: (1) refer suspected pathologic murmurs to a cardiologist, (2) obtain a chest radiograph (CXR) and electrocardiogram (ECG) and refer suspected pathologic murmurs to a cardiologist, (3) refer suspected pathologic murmurs for an echocardiogram (ECHO), (4) obtain a CXR and ECG and refer suspected pathologic murmurs for an ECHO, (5) refer all patients with murmurs to a cardiologist, or (6) refer all patients with murmurs for an ECHO. RESULTS: The least effective was strategy 1, which detects 82% of pathologic murmurs at $72 per patient evaluated. Strategy 5 detects 95% of pathologic murmurs at $38,000 per additional case detected over strategy 1. The most effective, strategy 6, detects 100% of pathologic murmurs at $158,000 per additional case detected over strategy 5. Strategies 2, 3, and 4 were not cost-effective. The results were sensitive to the costs of cardiology referral and ECHO. CONCLUSIONS: Adding a CXR and ECG to the pediatrician's evaluation, or selectively referring directly to ECHO increases costs with little gain in accuracy. Given the current cost constraints present in health care, whether the optimal strategy involves referring to a cardiologist or obtaining an ECHO for all patients with murmurs depends on how much society should allocate to diagnose pathologic murmurs.
2002

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Citation

Yi MS; Kimball TR; Tsevat J; Mrus JM; Kotagal UR, “Evaluation of heart murmurs in children: cost-effectiveness and practical implications,” Pediatric Palliative Care Library, accessed May 19, 2024, https://pedpalascnetlibrary.omeka.net/items/show/12916.