Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis

Area of Science:

• Medical Imaging
• Health Economics
• Pediatric Neurosurgery

Background:

• Acute shunt failure is a common complication in pediatric hydrocephalus management.
• Accurate and cost-effective diagnostic imaging is crucial for timely intervention.
• Cranial computed tomography (CT), fast sequence magnetic resonance imaging (fsMRI), and optic nerve sheath diameter (ONSD) measurement are potential diagnostic tools.

Purpose of the Study:

• To compare the cost-effectiveness of CT, fsMRI, and ONSD ultrasonography for diagnosing acute shunt failure in children.
• To evaluate different diagnostic imaging strategies from a healthcare organization's perspective.

Main Methods:

• A cost-effectiveness analysis was performed using a Markov model.
• Four diagnostic strategies were modeled: CT alone, fsMRI alone, ONSD screening (POCUS) followed by CT, and ONSD screening (POCUS) followed by fsMRI.
• Effectiveness was measured in quality-adjusted life-years (QALYs), and costs included short- and long-term expenses, such as radiation-induced cancer.

Main Results:

• When the pretest probability of shunt failure was 30%, screening with ONSD measurement via point-of-care ultrasound (POCUS) was the most cost-effective initial strategy.
• For patients with abnormal initial shunt series or ONSD measurements, fsMRI was more cost-effective than CT.
• A strategy involving CT alone was less effective and more expensive than strategies incorporating ONSD and fsMRI.

Conclusions:

• Ultrasonographic ONSD measurement is the preferred initial screening test for children with a low pretest probability of cranial shunt failure.
• Fast sequence magnetic resonance imaging (fsMRI) is a more cost-effective definitive imaging test compared to cranial CT for suspected shunt failure.