Cost-Effectiveness of Integrating a Clinical Decision Rule and Staged Imaging Protocol for Diagnosis of Appendicitis

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Sean GregoryAnupam B Kharbanda

Abstract

To evaluate the cost-effectiveness of a diagnostic protocol for appendicitis in children, the use of a validated clinical decision rule (CDR) and a staged imaging protocol, compared with usual care. We estimated the cost-effectiveness of the three competing strategies using parameters from existing literature as well as a Markov model developed to simulate the effects of exposure to ionizing radiation from a single computed tomography (CT) study in the course of diagnosis. The simulation model was applied to a hypothetical cohort of 100,000 boys and girls, age 10 years, presenting with acute abdominal pain to emergency departments in the United States. The integrated strategy, the CDR followed by staged imaging, was found to be the most cost-effective approach. Cost savings accrued from the reduction in CT utilization for low-risk patients compared with the other two strategies. The addition of ultrasound (US) to the CDR strategy reduced CT utilization by an additional 10.9%, its main cost advantage, with negligible change in net health benefits from false-negative US results, and associated morbidity or mortality. Results suggest that the integration of staged imaging with the CDR for the diagnosis of appendicitis in children ...Continue Reading

References

Jun 1, 1992·Pediatric Emergency Care·S L Reynolds, D M Jaffe
May 1, 1986·Annals of Emergency Medicine·A Alvarado
Feb 1, 1995·Journal of Pediatric Surgery·R H PearlD P Jaques
Apr 1, 1995·Annals of Internal Medicine·J TsevatL Goldman
Feb 1, 1993·Pediatric Emergency Care·S L Reynolds
Oct 9, 1996·JAMA : the Journal of the American Medical Association·L B RussellM C Weinstein
Sep 24, 1999·JAMA : the Journal of the American Medical Association·B M Garcia PeñaG A Taylor
Oct 28, 1999·PharmacoEconomics·N MittmannB A Liu
Jan 2, 2004·Pediatrics·Barbara M Garcia PeñaKenneth D Mandl
Jun 9, 2004·Journal of Pediatric Surgery·Benjamin A HagendorfRandall S Burd
Sep 6, 2005·Pediatrics·Anupam B KharbandaRichard G Bachur
Mar 27, 2007·Annals of Emergency Medicine·Carisa SchneiderRichard Bachur
Jul 27, 2007·JAMA : the Journal of the American Medical Association·David G BundyHenry E Rice
May 19, 2009·Pediatric Radiology·Andrea S Doria
Nov 3, 2010·British Medical Bulletin·Sarah J Whitehead, Shehzad Ali
Dec 24, 2011·The Journal of Pediatrics·Richard G BachurMichael C Monuteaux
May 25, 2012·AJR. American Journal of Roentgenology·Alisa K JohnsonJanice Gallant
Aug 2, 2012·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Genevieve SantillanesRoger J Lewis
Dec 26, 2012·Pediatrics·Jacqueline M SaitoPhillip I Tarr
Mar 30, 2013·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Don HusereauUNKNOWN ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force
Jun 23, 2015·JAMA Pediatrics·Richard G BachurMichael C Monuteaux

❮ Previous
Next ❯

Citations

Nov 5, 2016·Critical Ultrasound Journal·Jennifer R MarinResa E Lewiss
Feb 11, 2018·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Anupam B KharbandaUNKNOWN Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics
Aug 14, 2019·Hospital Pediatrics·Akshata Hopkins, Stephanie J Doniger
Nov 24, 2017·European Journal of Pediatrics·Maarten O BlankenUNKNOWN Dutch RSV Neonatal Network
Apr 17, 2020·World Journal of Emergency Surgery : WJES·Salomone Di SaverioFausto Catena
Mar 10, 2021·The Ultrasound Journal·Brian LentzNicholas Risko
Jan 23, 2020·Pediatrics·Rebecca JenningsDavene R Wright

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.