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Acute Appendicitis in Young Children: Cost-effectiveness of US versus CT in Diagnosis—A Markov Decision Analytic Model
Copyright policy )Acute Appendicitis in Young Children: Cost-effectiveness of US versus CT in Diagnosis—A Markov Decision Analytic Model
To compare the cost-effectiveness of different imaging strategies in the diagnosis of pediatric appendicitis by using a decision analytic model.Approval for this retrospective study based on literature review was not required by the institutional Research Ethics Board. A Markov decision model was constructed by using costs, utilities, and probabilities from the literature. The risk of radiation-induced cancer was modeled by using the Biological Effects of Ionizing Radiation VII report, which is based primarily on data from atomic bomb survivors. The three imaging strategies were ultrasonography (US), computed tomography (CT), and US followed by CT if the initial US study was negative. The model simulated the short-term and long-term outcomes of the patients, calculating the average quality-adjusted life span and health care costs.For a single abdominal CT study in a 5-year-old child, the lifetime risk of radiation-induced cancer would be 26.1 per 100,000 in female and 20.4 per 100,000 in male patients. In the base-case analysis, US followed by CT was the most costly and most effective strategy, CT was the second-most costly and second-most effective strategy, and US was the least costly and least effective strategy. The incremental cost-effectiveness ratios (ICERs) of CT to US and of US followed by CT to US were both well below the societal willingness-to-pay threshold of $50,000 (in U.S. dollars). The ICER of US followed by CT to CT was less than $10,000 in both male and female patients.In a Markov-based decision model of pediatric appendicitis, the most cost-effective method of imaging pediatric appendicitis was to start with a US study and follow each negative US study with a CT examination.
- University of Toronto Canada
- Hospital for Sick Children Canada
Microsoft Academic Graph classification: medicine.medical_specialty Cost effectiveness Decision tree Markov model Health care Medicine Medical physics Cost–benefit analysis business.industry Retrospective cohort study medicine.disease Appendicitis Surgery business Decision model
Male, Risk, Neoplasms, Radiation-Induced, Cost-Benefit Analysis, Radiation Dosage, Sensitivity and Specificity, Prevalence, Humans, Radiology, Nuclear Medicine and imaging, Retrospective Studies, Ultrasonography, Incidence, Decision Trees, Appendicitis, Markov Chains, Intestinal Perforation, Child, Preschool, Female, Tomography, X-Ray Computed, SEER Program
Male, Risk, Neoplasms, Radiation-Induced, Cost-Benefit Analysis, Radiation Dosage, Sensitivity and Specificity, Prevalence, Humans, Radiology, Nuclear Medicine and imaging, Retrospective Studies, Ultrasonography, Incidence, Decision Trees, Appendicitis, Markov Chains, Intestinal Perforation, Child, Preschool, Female, Tomography, X-Ray Computed, SEER Program
Microsoft Academic Graph classification: medicine.medical_specialty Cost effectiveness Decision tree Markov model Health care Medicine Medical physics Cost–benefit analysis business.industry Retrospective cohort study medicine.disease Appendicitis Surgery business Decision model
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).161 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 10% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 1% citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).161 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 10% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 1%
Citations provided by BIP!Popularity provided by BIP!- University of Toronto Canada
- Hospital for Sick Children Canada
To compare the cost-effectiveness of different imaging strategies in the diagnosis of pediatric appendicitis by using a decision analytic model.Approval for this retrospective study based on literature review was not required by the institutional Research Ethics Board. A Markov decision model was constructed by using costs, utilities, and probabilities from the literature. The risk of radiation-induced cancer was modeled by using the Biological Effects of Ionizing Radiation VII report, which is based primarily on data from atomic bomb survivors. The three imaging strategies were ultrasonography (US), computed tomography (CT), and US followed by CT if the initial US study was negative. The model simulated the short-term and long-term outcomes of the patients, calculating the average quality-adjusted life span and health care costs.For a single abdominal CT study in a 5-year-old child, the lifetime risk of radiation-induced cancer would be 26.1 per 100,000 in female and 20.4 per 100,000 in male patients. In the base-case analysis, US followed by CT was the most costly and most effective strategy, CT was the second-most costly and second-most effective strategy, and US was the least costly and least effective strategy. The incremental cost-effectiveness ratios (ICERs) of CT to US and of US followed by CT to US were both well below the societal willingness-to-pay threshold of $50,000 (in U.S. dollars). The ICER of US followed by CT to CT was less than $10,000 in both male and female patients.In a Markov-based decision model of pediatric appendicitis, the most cost-effective method of imaging pediatric appendicitis was to start with a US study and follow each negative US study with a CT examination.