title: Cost assessment of the evaluation of heart murmurs in children.
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.
authors.affiliation: Department of Pediatrics, University of Nebraska Medical Center, Omaha 68198-2166.
authors.forename: D A
authors.initials: DA
authors.lastname: Danford
authors.forename: A
authors.initials: A
authors.lastname: Nasir
authors.forename: C
authors.initials: C
authors.lastname: Gumbiner
mesh_terms: D002309:Cardiology / Q000191:economics* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004452:Echocardiography / Q000191:economics* / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006337:Heart Murmurs / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009329:Nebraska / Q000453:epidemiology; D010372:Pediatrics / Q000191:economics* / Q000592:standards; D012017:Referral and Consultation / Q000191:economics* / Q000592:standards; D012680:Sensitivity and Specificity