The cost-effectiveness of different strategies to evaluate optic disk drusen in children

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Marlen LeonScott R Lambert

Abstract

To compare the costs of diagnostic work-up for optic disk drusen where ophthalmic ultrasound was performed prior to imaging and invasive studies with those where ophthalmic ultrasound was performed after such studies. The medical records of patients <18 years of age evaluated at a tertiary referral center between 2007 and 2012 for "swollen" optic nerves were retrospectively reviewed. The main outcome measure was cost of diagnostic work-up according to Georgia Medicaid global reimbursement rates. A total of 46 children with a B-scan ultrasound-confirmed diagnosis of calcified optic disk drusen were included. Neuroimaging was performed in 23 patients, of whom 20 had the study prior to ophthalmic ultrasound. The mean cost of evaluations for patients undergoing ancillary testing prior to ophthalmic ultrasound was $1,173; for those undergoing ancillary testing after, $305. Because optic disk drusen can mimic the appearance of papilledema, it is more cost-effective to perform ophthalmic ultrasonography prior to neuroimaging, especially when the patient is asymptomatic. If ophthalmic ultrasonography confirms the presence of drusen, it is more cost-effective to reassess the clinical picture before proceeding with further tests.

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Citations

Oct 31, 2016·Survey of Ophthalmology·Melinda Y Chang, Stacy L Pineles
Aug 25, 2015·Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus·Scott R LambertAmy K Hutchinson
Aug 25, 2015·Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus·Mariya MoosajeeAnnegret Dahlmann-Noor
Jan 14, 2017·Acta Ophthalmologica·Kyoung Min LeeJeong-Min Hwang
Dec 14, 2018·Neuro-ophthalmology·Edward PalmerAnthony P Wells
Dec 27, 2018·International Ophthalmology Clinics·Edmund TsuiVaidehi S Dedania
Oct 11, 2017·Journal of Glaucoma·Gwendolyn GramerNicole Weisschuh
Oct 15, 2019·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·Peng Yong SimFaye Barampouti
Feb 25, 2021·Pediatric Blood & Cancer·Jesse L BerryA Linn Murphree
Aug 14, 2021·European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society·Dorothy A ThompsonRichard Bowman

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