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Intussusception in children: cost-effectiveness of ultrasound vs diagnostic contrast enema

Brian T Bucher1, Bruce L Hall, Brad W Warner

  • 1Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. bucherb@wudosis.wustl.edu

Journal of Pediatric Surgery
|June 21, 2011
PubMed

Insights

Ultrasound followed by contrast enema (US/CE) is more effective for diagnosing pediatric intussusception but also more costly than contrast enema (CE) alone. This strategy reduces radiation-induced malignancy risks in children.

Area of Science:

  • Pediatric imaging
  • Medical decision modeling
  • Health economics

Background:

  • Intussusception is a common pediatric surgical emergency.
  • Diagnostic imaging plays a crucial role in intussusception management.
  • Concerns exist regarding radiation exposure from diagnostic imaging in children.

Purpose of the Study:

  • To compare the cost-effectiveness of different imaging strategies for diagnosing pediatric intussusception.
  • To evaluate ultrasound followed by contrast enema (US/CE) versus contrast enema (CE) alone.
  • To utilize a decision analytic model for this comparison.

Main Methods:

  • A Markov decision model was developed for a hypothetical cohort of 2-year-old children.
  • The model simulated short-term and long-term outcomes, including radiation exposure effects.
  • Quality-adjusted life years (QALYs) and healthcare costs were calculated for each strategy.

Main Results:

  • The US/CE strategy significantly reduces radiation-induced malignancy cases compared to CE alone.
  • US/CE was found to be the most effective, albeit the most costly, initial imaging strategy.
  • Incremental cost-effectiveness ratios for US/CE versus CE were $70,100/QALY (boys) and $92,227/QALY (girls).

Conclusions:

  • Initial ultrasound followed by contrast enema (US/CE) is the most effective strategy for diagnosing pediatric intussusception.
  • While US/CE is more costly, its higher effectiveness and reduced radiation risks are key considerations.
  • The decision analytic model highlights the trade-offs between cost, effectiveness, and safety in pediatric imaging.
Abstract

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