A literature-based comparison of three methods of pediatric esophageal coin removal.
BACKGROUND
The choice among endoscopy, Foley catheter, and bougienage techniques for pediatric esophageal coin removal currently depends on local or personal preferences. This reflects a lack of prospective comparisons of cost and effectiveness in the literature.


METHODS
A computerized decision analytic model was used to determine the expected costs of each method of esophageal coin removal. Calculations were based on success rates in the recent literature and local patient charges for each method. Complications reported in this recent literature were also tabulated.


RESULTS
Of 1746 esophageal coin removal attempts reported in 24 papers, 1706 (97.7%) were successful. There were 37 (2.1%) complications, the majority of which were minor. The expected cost of endoscopic coin removal was $2701; of Foley catheter removal, $660; of bougienage removal, $614. The large difference in expected cost of endoscopy and bougienage or Foley catheter removal persisted in sensitivity analyses.


CONCLUSIONS
In a literature-based decision analytic model, pediatric esophageal coin removal by the Foley catheter or bougienage technique was far more cost-effective than was endoscopy.
Conners
G P
GP
Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, New York, USA.
D002404:Catheterization / Q000009:adverse effects / Q000191:economics; D002648:Child; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004106:Dilatation / Q000191:economics; D004945:Esophagoscopy / Q000009:adverse effects / Q000191:economics; D004947:Esophagus; D005547:Foreign Bodies / Q000191:economics / Q000628:therapy*; D006801:Humans; D012189:Retrospective Studies