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Cost assessment of the evaluation of heart murmurs in children
D A Danford1, A Nasir, C Gumbiner
1Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-2166.
Insights
For childhood heart murmurs, consulting a pediatric cardiologist is generally preferred over an initial echocardiogram. This approach is more cost-effective, especially when cardiologist evaluations and echocardiogram costs are moderate.
Area of Science:
- Pediatric Cardiology
- Health Economics
- Diagnostic Strategy Evaluation
Background:
- Childhood heart murmurs often require evaluation to distinguish innocent murmurs from serious cardiac conditions.
- Current diagnostic pathways involve either direct echocardiography or initial pediatric cardiology consultation.
Purpose of the Study:
- To compare the cost-effectiveness of two diagnostic strategies for evaluating childhood heart murmurs: an echocardiography-first approach versus a pediatric cardiology consultation-first approach.
- To determine the preferred strategy based on varying cost parameters and diagnostic yields.
Main Methods:
- A decision analysis model was developed to compare the costs of two strategies: (1) echocardiography first, then referral if needed; (2) cardiology referral first, then echocardiography if needed.
- The model incorporated data on heart disease probability, referral patterns, and echocardiogram utilization from a review of 388 patient records evaluated in a pediatric cardiology clinic.
Main Results:
- The echocardiography-first strategy was found to be $257 more expensive than the referral-first strategy.
- The cost advantage of the referral-first strategy remained robust across various model assumption changes.
Conclusions:
- Pediatric cardiology consultation is the preferred initial approach for childhood heart murmur evaluation.
- This preference holds when consultation costs are moderate, echocardiogram costs are moderate to high, and cardiologists infrequently order echocardiograms for innocent murmurs.
Abstract:
Echocardiography available directly to primary care physicians represents an alternative strategy to pediatric cardiology consultation for childhood heart murmur evaluation. A decision analysis model compared the costs of two diagnostic strategies: (1) echocardiography first, referral to the cardiologist if appropriate; and (2) cardiologist evaluates murmur, echocardiography if appropriate. The model incorporated probability of heart disease, frequency of cardiologist-ordered echocardiography, and echocardiography results established by review of 388 records of consecutive patients evaluated for murmurs in a pediatric cardiology clinic. Echocardiography-first strategy costs were $257 greater than referral-strategy costs. Referral-strategy advantages were not highly sensitive to changes in model assumptions. Pediatric cardiology consultation is the preferred approach provided (1) consultation costs are moderate, (2) echocardiography costs are moderate to high, and (3) the rate at which the cardiologist orders echocardiography for patients with innocent murmurs is low.